Positive Kleihauer-Betke Research Articles

Massive fetomaternal hemorrhage preceded by decreased fetal movement and a nonreactive fetal heart rate pattern

Massive fetomaternal hemorrhage occurs in one in 1000 deliveries and has been associated with decreased fetal movements and a sinusoidal fetal heart rate (FHR) pattern. Three women presented with decreased fetal movements, nonreactive FHR patterns, and positive Kleihauer-Betke tests. All three were at a viable gestational age and were immediately delivered by cesarean. The three infants were severely anemic, with hemoglobin levels of 6.5, 5.3, and 5.1 g/dL, respectively. A patient who presents with decreased fetal movement associated with a nonreactive FHR pattern and a positive Kleihauer-Betke test of more than 140 mL should be considered for immediate delivery if the gestational age is consistent with neonatal viability.

Massive fetomaternal hemorrhage preceded by decreased fetal movement and a nonreactive fetal heart rate pattern

Background: Massive fetomaternal hemorrhage occurs in one in 1000 deliveries and has been associated with decreased fetal movements and a sinusoidal fetal heart rate (FHR) pattern. Cases: Three women presented with decreased fetal movements, nonreactive FHR patterns, and positive Kleihauer-Betke tests. All three were at a viable gestational age and were immediately delivered by cesarean. The three infants were severely anemic, with hemoglobin levels of 6.5, 5.3, and 5.1 g/dL, respectively. Conclusion: A patient who presents with decreased fetal movement associated with a nonreactive FHR pattern and a positive Kleihauer-Betke test of more than 140 mL should be considered for immediate delivery if the gestational age is consistent with neonatal viability.(Obstet Gynecol 1993; 82:711-4)

Fetomaternal Hemorrhage in Threatened Abortion

In this study, we compared the incidence of fetomaternal hemorrhage between patients with threatened abortion and a control population of similar gestational age. The study population comprised pregnant patients at less than 20 weeks' gestation who presented to our emergency room with a history of vaginal bleeding without cervical dilatation or passage of tissue. The control population consisted of women presenting for elective pregnancy termination; they were excluded from the study if they gave a history of any antepartum bleeding. The amount of fetomaternal hemorrhage was evaluated using the Kleihauer-Betke acid elution assay. A positive result in our laboratory, as determined by a nonpregnant control group, was a value of 0.07% or more fetal cells. Using this criterion, 11% of the study population had a positive Kleihauer-Betke test, compared with 4% in the pregnant control group. Rho(D) immunoglobulin may be indicated in Rho(D)-negative patients who present with threatened abortion.

Ultrasonographic diagnosis of a large placental intervillous thrombosis associated with elevated maternal serum α-fetoprotein level

A placental lesion associated with elevated maternal serum «-fetoprotein level and a positive Kleihauer-Betke test is reported. Serial ultrasonograms showed a progressive increase in the echogenicity of the lesion that corresponded to a large intervillous thrombosis after delivery. This case illustrates the importance of detailed ultrasonographic and pathologic placental investigations in pregnancies with unexplained elevated levels of a-fetoprotein. (Am J Obstet Gynecol 1990;163:1558-60.)

Clinical use of the Kleihauer-Betke test

Results of all Kleihauer-Betke (KB) tests performed in 1988, at a center with 4,201 deliveries, were reviewed. Two hundred and twenty-seven tests were performed on maternal specimens from 205 patients. Eighteen (8.8%) of the 205 patients had positive test results. Medical records were available for 147 (71.7%) of the patients, including 17 of the 18 patients with a positive result. Indications for testing were: vaginal bleeding (33%), maternal trauma (31%), unexplained fetal death (5%), Rh incompatibility (3%), fetal distress (3%), and miscellaneous (24%). Most of the tests were performed antepartum. In only one case, and without clear benefit, did the KB test prompt a clinical intervention. At least two of the 18 patients with positive test results had probable false positive results due to maternal hemoglobin F. Such false positive KB test results may be misleading. Further evaluation of the role of the KB test in obstetrical management is needed.

Virilization of the female fetus with maternal danazol exposure

suggested the possibility of fetomaternal hemorrhage. In such cases, the possibility that intrapartum hemorrhage may have contributed to the positive KleihauerBetke smear cannot be excluded. This case is unique in several respects. A sinusoidal FHR pattern associated with antepartum documentation of fetomaternal transfusion and fetal anemia has, to our knowledge, not been reported . The degree of fetomaternal transfusion (representing approximately 265 ml of fetal blood) reported here is massive , yet, because of its presumably chronic nature, the infant was fairly well compensated, as evidenced by neonatal hemodynamic stability and absence of ascites on ultrasound. Prolonged anemia with progressive loss of oxygen-carrying capacity may lead to hypoxia and metabolic acidosis. Analysis of such cases has led several authors to postulate hypoxia of the cardiac center with derangement of central nervous system control of the heart rate as the final common pathway in the production of a sinusoidal pattern. This fetus was experiencing neither systemic hypoxia nor acidosis. However, the possibility exists that severe anemia may lead to local, relative hypoxia of specialized tissues such as the central nervous system cardiac center. The uniformly poor neonatal outcome which has been associated with the presence of true sinusoidal FHR patterns may be due to the detection of primarily near end-stage cases. The sinusoidal FHR pattern which led to fortuitous intervention after premature rupture of the membranes certainly would not have been apparent with auscultation alone. That the availability of electronic FHR monitoring and the recognition of the significance of the pattern under discussion saved this infant's life seems beyond doubt.