Kleihauer-Betke

[pbaker]

For those of you that have OB departments, I am interested in how many KB stains you perform, what your turn-around time is (is it considered a STAT test??) and if you know what the doctors do with the information? We do a lot on Rh + women who have fallen, been in crashes, etc., so it is not for Rhogam determination. Have you had any instances where a clinical decision was made (ex. deliver the baby) based on this one test?

[David Saikin]

We do about 4/month . . . mostly for abdominal traumas, rarely a + fetal screen. I had on OB who did them before and after versions to see if he compromised the placental circulation.

[PAWHITTECAR]

Here it is a send out test. Since I came in September we have sent 1 because the fetal screen was positive and 1 on a Rh + pt that was in an automobile accident. Neither sent stat and in the case of the trauma I'm pretty sure they sis not use the result because she was discharged home before we even had the result.

[jalomahe]

We have both OB and trauma services and we perform KB stains for other facilities. We do about 4-6 KB stains a month. The test can be ordered STAT with a TAT of 2 hours.

KB stains are usually a test that is not ordered off the cuff....If docs are ordering it they are interested in the results and do look at the results. The results do influence their clinical decision making. Their clinical decision may be no additional intervention is required (Negative KB); monitor fetus and mom (Postive KB indicating low volume of fetal blood) with repeat of KB stain after several hours to see if there is a change; to intervene in the pregnancy up to and including delivery of the baby.

Additionally we have performed KB stains to investigate why an infant is born with a low Hct when there is no overt signs of bleeding in the infant. Recently we had a full term infant born with a Hct of 20. Both pre and post delivery specimens from the mom showed a high volume of fetal blood in the mother's circulation. The conclusion from the neonatologist was that there had been an ongoing fetal-maternal transfusion occurring.

[ChrisH]

We are doing about 3 per month, they are not stat due to not being able to turn them out within our 60 minute (draw to resulted window). We will do them on those with Fetal Stain positive and those OB patients with abdominal trauma (they are looking for fetal bleeding).

[Barb Thompson]

We offer it as a stat with a turn around time of 4 hours (although the OB dept thinks they should get a result in less than 20 minutes). We do it more for OB patients with abdominal trauma rather than a positive fetal screen. I don't know if the doctors look at the results. Usually the patient has been discharged before we get it done. We do maybe 1 every other month.

[AMcCord]

Kleihauer-Betke may also be ordered for investigation of fetal demise.