Large FMH

[gagpinks]

Hi all

Today i have seen another interesting case in my 15 years career. Some of you might already have seen.

Mum A Rh D Pos.  Antibody screen negative , baby's DAT negative , xmatch found to be compatible with baby red cell and mum plasma.  No sigh of haemolysis , bilirubin normal only baby's Hb is 70g/l . Result phoned to clinician and they requested FMH test . Kleihauer test is positive and approximately look 70-80 ml bleed. 

Is there any technique or test to confirm this large FMH in case of Rh positive mum  ? Do we have to think anything else in terms of transfusion side.? 

[Malcolm Needs ☆]

13 minutes ago, gagpinks said:

Is there any technique or test to confirm this large FMH in case of Rh positive mum  ? Do we have to think anything else in terms of transfusion side.? 

Yes.  In the same way that use FITC-labelled monoclonal anti-D to estimate an FMH when the mum is D Negative and the baby is D Positive using flow cytometry, you can use FITC-labelled anti-HbF to estimate an FMH by flow cytometry when the mother and baby are either both D Positive or both D Negative, BUT, and it is a big but, there has, as far as I know, never been sufficient evidence that this is in any way accurate, but it will give you some idea (not that many Reference Laboratories in the UK will do this since both MHRA and UKAS have reared their ugly heads).  However, I have a question for you!  If you already know the baby's Hb (70gL^-1, and not 70g/l incidentally, but in any case it should have been 70 g/L - remember, I will be marking your HSD papers!), why would you want to confirm the volume of the FMH?  It is irrelevant, in that it will not any difference whatsoever to the way the case is handled - the baby still needs a transfusion!

IN terms of transfusing the baby, no, you just give the normal blood that you would give any baby.

[gagpinks]

9 minutes ago, Malcolm Needs said:

Yes.  In the same way that use FITC-labelled monoclonal anti-D to estimate an FMH when the mum is D Negative and the baby is D Positive using flow cytometry, you can use FITC-labelled anti-HbF to estimate an FMH by flow cytometry when the mother and baby are either both D Positive or both D Negative, BUT, and it is a big but, there has, as far as I know, never been sufficient evidence that this is in any way accurate, but it will give you some idea (not that many Reference Laboratories in the UK will do this since both MHRA and UKAS have reared their ugly heads).  However, I have a question for you!  If you already know the baby's Hb (70gL^-1, and not 70g/l incidentally, but in any case it should have been 70 g/L - remember, I will be marking your HSD papers!), why would you want to confirm the volume of the FMH?  It is irrelevant, in that it will not any difference whatsoever to the way the case is handled - the baby still needs a transfusion!

IN terms of transfusing the baby, no, you just give the normal blood that you would give any baby.

Thanks Malcolm! !

 I will be carefull in my exam. This was interesting case ,just want to confirm our performance.  Baby already had 4 unit paediatric pack.