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Detection of fetal‐maternal hemorrhage in a mother with sickle trait and hereditary persistence of fetal hemoglobin

An Rh‐negative term primigravida with sickle trait and hereditary persistence of fetal hemoglobin and an Rh‐positive infant were evaluated postpartum for fetal‐maternal hemorrhage (FMH) by the acid‐elution test for fetal hemoglobin (HbF) cells. Using the acid‐elution test, 100 percent of the cells contained HbF. The patient received one vial of Rh immune globulin and was discharged. This report illustrates that lack of specificity is a major problem of the acid‐elution test for detection of fetal‐maternal hemorrhage, due to its failure to differentiate true fetal Rh‐positive cells from maternal Rh‐negative HbF cells. Moreover, productivity studies suggest performance of agglutination tests such as the immune rosetting test is more convenient than performance of the acid‐elution test to screen for FMH. The recently developed enzyme‐linked antiglobulin test, however, may replace both of these procedures for detection of FMH.