Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지
DOI QR코드

DOI QR Code

Acute Fetomaternal Hemorrhage Confirmed by Maternal Alfa-Fetoprotein in Monochorionic Diamniotic Neonates under 1,500 g

  • Yoo, Chaeri (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Han, Sol (Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine) ;
  • Jeong, Hyemi (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Heo, Ju Sun (Department of Pediatrics, Korea University Anam Hospital) ;
  • Lee, Hyun-Seung (Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine) ;
  • Jeon, Jihyun (Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine)
  • Received : 2020.06.10
  • Accepted : 2020.07.29
  • Published : 2020.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Fetomaternal hemorrhage (FMH) is due to the entry of fetal blood into the maternal circulation. Although very rare, FMH complicates pregnancies, presents with severe symptoms, and leads to fetal death. Majority of FMH cases are idiopathic and difficult to diagnose. The known used diagnostic tests are Kleihauer-Betke Test (KBT) and flow cytometry, which can detect fetal hemoglobin in the maternal blood. However, such methods have limited use because of low sensitivity, labor-intensive and error-susceptible procedures, poor reproducibility, and tendency to overestimate the FMH volume. Other tests include high performance liquid chromatography (HPLC) and alpha-fetoprotein (AFP) tests, which can be as favorable to confirm FMH as KBT. However, in case of acute FMH, the diagnostic results of KBT, flow cytometry, and HPLC may be false negative. AFP test is a noninvasive, fast, easily assessable, adjuvant, and confirmatory diagnostic test. Published Korean articles show confirmed FMH by KBT or HPLC in singleton late-preterm and term neonates. Herein, we report a case of monochorionic diamniotic twin neonates (birth weight <1,500 g) who presented borderline fetal hemoglobin level because of acute FMH and were diagnosed with FMH by maternal AFP. Our experience of diagnosing FMH rapidly by AFP test will be very helpful to clinicians for the prevention and treatment of FMH during pregnancy.

Keywords

References

  1. Menendez Hernando C, Chacon Aguilar R, Farinas Salto M, Perez Crespo R, Martin Molina R, Moreno Novillo R, et al. Severe neonatal anemia due to fetomaternal hemorrhage: an ilustrative case. Arch Argent Pediatr 2019;117:e142-6.
  2. Solomonia N, Playforth K, Reynolds EW. Fetal-maternal hemorrhage: a case and literature review. AJP Rep 2012;2:7-14.
  3. Ahmed M, Abdullatif M. Fetomaternal transfusion as a cause of severe fetal anemia causing early neonatal death: a case report. Oman Med J 2011;26:444-6. https://doi.org/10.5001/omj.2011.113
  4. Weisberg L, Kingdom J, Keating S, Ryan G, Seaward G, Kelly E, et al. Treatment options in fetomaternal hemorrhage: four case studies. J Obstet Gynaecol Can 2004;26:893-8. https://doi.org/10.1016/s1701-2163(16)30140-2
  5. Den Besten G, van der Weide K, Schuerman FA, Michael Cotten C, Rondeel JM. Establishing the cause of anemia in a premature newborn infant. Lab Med 2018;49:e74-7.
  6. Thomas A, Mathew M, Unciano Moral E, Vaclavinkova V. Acute massive fetomaternal hemorrhage: case reports and review of the literature. Acta Obstet Gynecol Scand 2003;82:479-80. https://doi.org/10.1080/obs.82.5.479
  7. Doshi K, Shastry S, Shivhare A, Raturi M. Cellular mimicry in Kleihauer-Betke assay. Glob J Transfus Med 2016;1:85-7. https://doi.org/10.4103/2455-8893.189852
  8. Duguid JK, Bromilow IM. Laboratory measurement of fetomaternal hemorrhage and its clinical relevance. Transfus Med Rev 1999;13:43-8. https://doi.org/10.1016/S0887-7963(99)80087-X
  9. Stefanovic V. Fetomaternal hemorrhage complicated pregnancy: risks, identification, and management. Curr Opin Obstet Gynecol 2016;28:86-94. https://doi.org/10.1097/GCO.0000000000000248
  10. Scientific subcommittee of the Australian & New Zealand Society of Blood Transfusion Inc. Guidelines for laboratory assessment of fetomaternal haemorrhage. Sydney: The Society, 2002:1-14.
  11. Kim YA, Makar RS. Detection of fetomaternal hemorrhage. Am J Hematol 2012;87:417-23. https://doi.org/10.1002/ajh.22255
  12. Choi JW, Oh JH, Seok JE, Lee YJ, Oh YK. A case of matemal hemorrhage. J Korean Soc Neonatol 1999;6:272-5.
  13. Kim HK, Choi MY, Yoon HS, Yun BY, Bae SW, Son DW. Clinical study on massive fetomaternal hemorrhage. Korean J Perinatol 2001;12:267-73.
  14. Lee CH, Kim JK, Han MK, Kim JW, Lee JJ. Two cases of massive fetomaternal hemorrhage treated by exchange transfusion. Korean J Perinatol 2008;19:203-8.
  15. Park HC, Park SK, Choi MS. Neonatal severe anemia due to massive fetomaternal hemorrhage. Perinatology 2019;30:40-5. https://doi.org/10.14734/PN.2019.30.1.40
  16. Giacoia GP. Severe fetomaternal hemorrhage: a review. Obstet Gynecol Surv 1997;52:372-80. https://doi.org/10.1097/00006254-199706000-00022
  17. Maier JT, Schalinski E, Schneider W, Gottschalk U, Hellmeyer L. Fetomaternal hemorrhage (FMH), an update: review of literature and an illustrative case. Arch Gynecol Obstet 2015;292:595-602. https://doi.org/10.1007/s00404-015-3686-1
  18. Stroustrup A, Plafkin C. A pilot prospective study of fetomaternal hemorrhage identified by anemia in asymptomatic neonates. J Perinatol 2016;36:366-9. https://doi.org/10.1038/jp.2015.211
  19. Verco CJ, Jones WR. Monoamniotic twin pregnancy complicated by massive fetal-maternal haemorrhage. Aust N Z J Obstet Gynaecol 1981;21:186-7. https://doi.org/10.1111/j.1479-828X.1981.tb00917.x
  20. Watanabe N, Jwa SC, Ozawa N, Sago H. Sinusoidal heart rate patterns as a manifestation of massive fetomaternal hemorrhage in a monochorionic-diamniotic twin pregnancy: a case report. Fetal Diagn Ther 2010;27:168-70. https://doi.org/10.1159/000283513