Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

Presentation Icons

Additional registration fee required

Faculty have requested this content not be shared on social media

CME Credit Offered

Poster Icons

Foundation Awardee

No Social Media

Back

Q&A

Fetus

Poster Session 3

(654) Hemoglobin Electrophoresis versus Kleihauer Betke to Determine Bone Marrow Suppression in Fetuses Undergoing Intrauterine Transfusion

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Alexander M. Saucedo, MD

MFM Fellow
University of Texas at Austin, Dell Medical School
Austin, TX, United States

Coauthor(s)

EM

Erin Moise, PA-C

University of Texas at Austin, Dell Medical School
Austin, TX, United States
MN

Mark Nwokocha, MPH

University of Texas at Austin, Dell Medical School
Austin, TX, United States
MB

Michael Bebbington, MD

University of Texas at Austin, Dell Medical School
Austin, TX, United States
Kenneth Moise, Jr., MD (he/him/his)

Professor, Department of Women's Health; Co-Director, Comprehensive Fetal Care Center
Dell Medical School, University of Texas at Austin
Austin, TX, United States

Objective: The mainstay therapy for fetuses affected by red cell alloimmunization is serial intrauterine transfusions (IUTs). Confirmatory testing to determine when the fetal red cell pool has been replaced with donor cells historically involves the use of the Kleihauer-Betke (KB) stain. Hemoglobin (Hgb) electrophoresis testing may be more rapid with a reduced cost of analysis. We aim to determine the correlation between fetal Hgb electrophoresis versus the traditional KB stain.

Study Design: This is a prospective cohort of all alloimmunized singleton pregnancies undergoing IUT between 1/1/2021 and 7/1/2023. Maternal and fetal characteristics were collected along with indication for IUT. A final fetal blood sample was obtained at the conclusion of each transfusion and sent for KB and Hgb electrophoresis. The primary outcome was the assessment of these parameters in their ability to predict replacement of the fetal circulating red cell population with donor cells. Linear regression analysis and repeated measures analysis of variance were performed, P values less than 0.05 were considered significant.

Results: A total of 56 IUTs were performed in 16 patients. There were 39 (69.6%) final KB stain values collected and compared to 30 (53.6%) final Hgb electrophoresis values. Hgb electrophoresis when compared to the KB stain demonstrated a significant correlation (R² = 0.93; 95% CI, 0.61-0.76; P < 0.001). This same finding held true when examining correlation at each individual IUT as well. The final KB stain and Hgb electrophoresis value significantly decreased with each transfusion (P=0.003). A predominance of adult donor blood was noted by the third transfusion for both lab indices.

Conclusion: Fetal Hgb electrophoresis obtained at time of IUT demonstrates a significant correlation with the traditional KB stain. Given the increased cost, training, and time necessary to obtain a KB stain; substitution for an automated Hgb electrophoresis should be considered with comparable results.