Validity of the current anti-D immunoglobulin doses for the prevention of hemolytic disease of the newborn in Duhok/Iraq

The current study was initiated to evaluate the comparability of fetomaternal hemorrhage (FMH) measurement using flow cytometry (FCM) and Kleihauer–Betke test (KBT) and also to evaluate the validity of the current anti-D immunoglobulin doses for the prevention of hemolytic disease of the newborn in Duhok/Iraq. The current study included 101 pregnant women with Rh(D)-negative blood group who had Rh (D)-positive husbands. Their blood was tested for blood groping, FMH by FCM and KBT, and indirect Coombs test, 1 h following sensitizing events and 72 h after giving anti-D. Furthermore, blood from newborns was examined for blood group and direct Coombs test. The main sensitizing event was parturition (62.4%) followed by cesarean section (32.7%). The indirect Coombs was positive in 32 cases while the direct Coombs test was positive in 19 cases. In 63.4% of cases, the ABO blood groups were incompatible between mothers and their babies. When FMH was checked by KBT method, it was found that 16 (15.8%) participants had FMH ranging 1.2–51 mL (median 4.35 mL), while FMH was positive in 27 (26.7%) participants by FCM method ranging 1.2–54.4 ml (median 9.5 mL). About 4–5 patients had FMH (measured by KBT and FCM, respectively) of >12 mL and only 1% had a volume of >30 mL. The difference between KBT and FCM for FMH measurement was statistically significant with P < 0.001 when assessed by paired t-test and has a highly significant positive correlation with each other. The correlation of FMH was statistically significant with maternal gravidity, number of anti-D received before (moderate positive correlation), gestational age, and newborn hemoglobin (negative correlation). However, the correlation was not significant between FMH and the following factors: maternal parity, maternal hematological parameters, and ABO compatibility of mother and their babies with P > 0.05. Inadequate doses of anti-D had been given previously that resulted in sensitization in at least one-quarter of the cases, and this necessitated proper measurement of FMH in all Rh (D) mothers following sensitizing events.