Kleihauer Test
Kleihauer Test
Kleihauer Test
King Edward Memorial Hospital CLINICAL GUIDELINES SECTION A: OBSTETRICS AND GYNAECOLOGY GUIDELINES
A KLEIHAUER TEST SHOULD NOT BE REQUESTED IN THE SETTING OF AN ANTEPARTUM HAEMORRHAGE IN ORDER TO DIAGNOSE ABRUPTION. THIS IS AN INAPPROPRIATE USE OF THE TEST. URGENT KLEIHAUER TESTING The indications for an urgent Kleihauer Test are rare. Such requests shall be accompanied by a phone call from the ordering clinician to Transfusion Medicine (TM). An urgent Kleihauer test should be ordered ONLY in the following situations: Significant maternal abdominal trauma, when the CTG is not reassuring and/or the fetus is inactive on ultrasound.
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
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Non immune fetal hydrops in association with an abnormally raised MCA PSV. Sinusoidal fetal heart rate trace in a non-immunised woman. Decreased fetal movements after two consecutive non-reactive CTGs and/or an inactive fetus on ultrasound. NOTE: If the first CTG shows a sinusoidal pattern then the Kleihauer Test can be requested immediately.
TESTING AT THE TIME OF BIRTH / POSTPARTUM Maternal sample A pre-delivery Group & Hold sample ( a kleihauer is not performed on this sample) should be collected and sent to haematology for testing on admission to the Maternal Fetal Assessment Unit/ Labour and Birth Suite (or the Pre-Admission Clinic if an elective Caesarean section birth is planned) if: o o o o atypical red cell antibodies are present, the womans serological history is unknown, prophylactic RhD-Ig has been given in the previous 3 months, there is an increased risk of requiring a blood transfusion.
In order to determine the extent of the FMH and therefore the appropriate dose of RhD-Ig, a maternal Kleihauer sample must be taken from all Rh(D) negative women who have given birth to a Rh(D) positive infant and who do not have preformed immune anti-D antibodies. Ideally, the sample should be routinely collected a minimum of 15 minutes after placental separation and preferably within 2 hours to allow sufficient time for any fetal red cells to be dispersed in the maternal circulation. In exceptional circumstances, Kleihauer Tests may be collected up to 72 hours after the event but this increases the risk that that any additional doses of RhD-Ig needed for large FMH will not be administered within the required 72 hours.
If the FMH is greater than 6mL of Rh(D) positive packed fetal red cells, TM will contact the ward and supply additional doses of RhD-Ig as required. A negative Kleihauer Test indicates that one dose of RhD-Ig is sufficient.
CORD SAMPLE A cord blood sample is collected from all babies born at KEMH and sent to TM. A request for blood group and a Direct Antiglobulin Test (DAT) should be made for all infants born to a mother who: is Rh(D) negative or, has known clinically significant antibodies or, has unknown maternal blood group and antibody status. Where the cord sample is Rh(D) positive and the mother is Rh(D) negative, RhD-Ig will be supplied by TM for administration to the mother without delay. A request for a blood group and DAT should be made for all infants with unexplained neonatal jaundice and, where the DAT is positive, a bilirubin estimation should be performed on the cord blood. In addition, a haemoglobin level should be determined on a peripheral blood sample taken from the infant.
Date Issued: November 2003 Date Revised: February 2011 Review Date: February 2014 Written by:/Authorised by: OGCCU Review Team: OGCCU /TM 2009 1.9.2 The Kleihauer Test Section A Clinical Guidelines King Edward Memorial Hospital Perth Western Australia Page 2 of 3
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Note: When a Rh(D) negative mother receives RhD-Ig during pregnancy, especially as routine prophylaxis at 28-30 and 34-36 weeks gestation: the Rh(D) positive infant may be born with a positive DAT but have no evidence of haemolysis and the maternal sample will often show anti-D reactivity, as the half-life of passive RhD-Ig in the absence of significant FMH, is approximately 21 days.
REFERENCES
1. 2. 3. 4. Haematology: Transfusion Medicine Protocols, 13 RhD Immunoglobulin, 13.3 RhD-Ig Immunoglobulin Products and Applications 2010 Haematology: Transfusion Medicine Protocols, 13 RhD Immunoglobulin, 13.1 Fetal Maternal Haemorrhage and Postpartum Complication 2010 Haematology: Transfusion Medicine Protocols, 13 RhD Immunoglobulin, 13.2 The Kleihauer Test 2010 Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Antenatal screening Tests. 2006 http://www.ranzcog.edu.au/publications/statements/C-obs3.pdf Rh(D) immunoglobulin (Anti-D) in obstetrics. 2007 http://www.ranzcog.edu.au/publications/statements/Cobs6.pdf Urbaniak, SJ. Royal College of Physicians of Edinburgh/Royal College of Obstetricians and Gynaecologists consensus conference on anti-D prophylaxis 7 & 8 April 1997. Transfus Med. 1997;7:143-144.
5. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Guidelines for the use of
6. 7.
Guidelines on the prophylactic use of Rh D immunoglobulin (Anti-D) in obstetrics. NHMRC Main Report. Endorsed 22 March 1999 pp 27-30. 8. Huchet J, Dallemagne S, Huchet C, Brossard Y, Larsen M, Parnet-Mathieu F. Ante-partum administration of preventive treatment of Rh-D immunization in rhesus-negative women. Parallel evaluation of transplacental passage of fetal blood cells. Results of a multicenter study carried out in the Paris region. J Gynecol Obstet Biol Reprod 1987;16:101-111. 9. Bowman JM, Pollock JM. Antenatal prophylaxis of Rh isoimmunization: 28-weeks'-gestation service program.Can Med Assoc J. 1978;118:627-630. 10. Hermann M, Kjellman H, Ljunggren C. Antenatal prophylaxis of Rh immunization with 250 micrograms anti-D immunoglobulin. Acta Obstet Gynecol Scand Suppl. 1984;124:1-15.
Date Issued: November 2003 Date Revised: February 2011 Review Date: February 2014 Written by:/Authorised by: OGCCU Review Team: OGCCU /TM 2009
1.9.2 The Kleihauer Test Section A Clinical Guidelines King Edward Memorial Hospital Perth Western Australia Page 3 of 3
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual