Chen Jenn C, Davis Bruce H, Wood Brent, Warzynski Michael J
Department of Clinical Pathology, William Beaumont Hospital, Royal Oak, Michigan, USA.
Cytometry. 2002 Dec 15;50(6):285-90. doi: 10.1002/cyto.10154.
Enumeration of fetal red blood cells (RBCs) is important in the management of fetomaternal hemorrhage (FMH), particularly in situations of Rh incompatibility.
We evaluated results from three institutions using the flow cytometric method (FCM) to detect fetal RBCs based on the anti-hemoglobin F (HbF) monoclonal antibody method.
During 1997-2001, 69 of 1248 patients (5.5%) had measurable fetal erythrocytes (RBCs) in maternal blood. Only 21 patients (1.7%) had more than 30 mL of fetal blood detected in maternal blood. Of the 11 patients with large FMH and clinical follow-up, 7 had fetal demise (64%). In positive samples, significant differences were found in the fluorescence intensity (FI) of anti-HbF antibody staining between HbF-negative erythrocytes (HbF-) and adult HbF containing erythrocytes (F cells; 4 +/- 0 versus 57 +/- 9 linear mean channels [LMC]; P < 0.001) and between HbF-cells and fetal RBCs (4 +/- 0 versus 433 +/- 136 LMC; P < 0.001). In addition, significant differences were observed in forward light scatter intensity between HbF-cells and fetal RBCs (298 +/- 15 versus 355 +/- 68 LMC, P = 0.03). The transportability of the test is also addressed by comparing results from two other laboratories. The experience of our three laboratories, as well as the results from the recently reinitiated College of American Pathologists survey, which compares FCM and manual methods, clearly documents the superiority of the FCM test over the manual Kleihauer-Betke (KB) test.
The FCM is a simpler, more objective, and more precise alternative to the KB method in clinical testing. The high mortality rate associated with large FMH and therapeutic implications of these results should give laboratories motivation to abandon the KB method with more robust FCM to detect FMH.
胎儿红细胞（RBC）计数在胎儿-母体出血（FMH）的管理中很重要，尤其是在Rh血型不相容的情况下。
我们评估了三个机构使用流式细胞术（FCM）基于抗血红蛋白F（HbF）单克隆抗体法检测胎儿RBC的结果。
在1997年至2001年期间，1248例患者中有69例（5.5%）母体血液中可检测到胎儿红细胞（RBC）。只有21例患者（1.7%）母体血液中检测到超过30 mL的胎儿血液。在11例有大量FMH且有临床随访的患者中，7例胎儿死亡（64%）。在阳性样本中，HbF阴性红细胞（HbF-）与含成人HbF的红细胞（F细胞）之间抗HbF抗体染色的荧光强度（FI）存在显著差异（4±0对57±9线性平均通道[LMC]；P<0.001），HbF细胞与胎儿RBC之间也存在显著差异（4±0对433±136 LMC；P<0.001）。此外，HbF细胞与胎儿RBC之间在前向光散射强度上也观察到显著差异（298±15对355±68 LMC，P = 0.03）。通过比较另外两个实验室的结果，也探讨了该检测方法的可转移性。我们三个实验室的经验，以及最近重新启动的美国病理学家学会调查结果（该调查比较了FCM和手工方法），清楚地证明了FCM检测优于手工Kleihauer-Betke（KB）检测。
在临床检测中，FCM是一种比KB方法更简单、更客观、更精确的替代方法。与大量FMH相关的高死亡率以及这些结果的治疗意义应促使实验室放弃KB方法，采用更强大的FCM来检测FMH。
