Question: What is the role of Kleihauer testing in antepartum haemorrhage when the blood group is Rhesus positive?
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Answer: One guideline was identified that discusses the use of Kleihauer testing in antepartum haemorrhage: The Working Party of the British Committee for Standards in Haematology, Transfusion Taskforce "Guidelines for the Estimation of Fetomaternal Haemorrhage" says:
Tests for FMH estimation are not required:
- When the woman is D positive
Maternal samples should be tested with saline reacting IgM anti-D reagents that do not detect DVI (BCSH 2006b, BCSH 2004). Women testing D positive using these reagents are unlikely to make anti-D that will adversely affect the baby. If there is any doubt, arrange further testing at a reference laboratory and treat as D negative until results of these tests are available.
- In D positive women with unexplained abdominal pain in late pregnancy, FMH tests (by AE[acid elution]) are of limited diagnostic use. More sensitive and specific tests exist to investigate suspected placental abruption.
(Evidence level IV)
The RCOG is currently preparing a green-top guideline on Antepartum haemorrhage. The draft version recommends the Kleihauer test in Rhesus negative women only. The document also says:
The Kleihauer test is not a sensitive test for diagnosing abruption.
N.B. This information is taken from a draft document and is not the final recommendation.
References:
- Working Party of the British Committee for Standards in Haematology, Transfusion Taskforce. Guidelines for the Estimation of Fetomaternal Haemorrhage. 2009
- RCOG DRAFT Green-top guideline. Antepartum Haemorrhage. The final guidance will be published here
Search date: June 2011
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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