Comparison of fetomaternal hemorrhage detection methods and Rh immune globulin usage

A 1977 College of American Pathologists survey of hospitals has been analyzed to compare Rh immune globulin usage (RhIgG) with methods used to screen and confirm fetomaternal hemorrhage (FMH). The survey data show that there is a correlation between the rate of multiple vial usage and the confirmation method used. Laboratories using Fetaldex administered multiple vials of Rh immune globulin significantly more often than laboratories using other acid elution technics. This difference was independent of the screening methods used and was not related to the number of patients tested in laboratories giving fewer than 300 vials of Rh immune globulin per year. The incidence of fetomaternal hemorrhages of greater than 30 ml has been reported to be 0.3% by various groups using Kleihauer procedures to test large numbers of women after delivery. In 61 of 374 laboratories using Fetaldex and 15 of 253 laboratories using Kleihauer-Betke procedure more than ten times the expected number of recipients were given multiple vials.