Medical Necessity Documentation:
Client Notes:
Patient Preparation:
For mothers Rh-Negative, Rh Immuno Globulin (RhIG) prophylaxis is indicated, one RhIG dose can be administered STAT, and the laboratory will follow-up when testing is completed if additional doses are recommended.
Specimen Requirements:
3.0 mL of Mothers Maternal peripheral, Whole Blood Lavender Top tube - EDTA
Collection Instructions:
Collect within 1 to 24 hours post delivery or immunizing (procedure, trauma) event
Origianl Tube/Specimen must be received by PRMC Laboratory Flow Cytometry Mon-Friireceived by 12 noon, Saturday received by 12noon.
Minimum Volume:
1.0 mL Whole Blood
Transport & Storage: Temperature/Stability:
48 hours Ambient
72 hours Refrigerated
Rejection Criteria:
Cord blood; hemolized Clotted
Reference Range:
<=1.5mL fetal RBCs present in normal adults.
Critical Ranges:
Test Comments:
This test was developed and its performance characteristics determined by Parkview Health laboratories. This test has not been cleared or approved by the US Food and Drug Administration. The test is used for clinical purposes. It should not be regarded as investigational or for research. The laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) as qualified to perform high complexity clinical laboratory testing.
Methodology:
Flow Cytometry
Clinical Significance:
To detect and quantify the volume of fetomaternal hemorrhage in pregnant and post partum women (Rh-positive and Rh-Negative mothers). To determine if an Rh-negative mother needs more than one vial of Rh Immune Globulin (Rhogam) postpartum or after immunizing event (trauma, procedure).
Documentation:
For Rh-Negative mothers with Rh-Postive baby, test is reflexed if Fetal Screen is positive, to determine if additional vials of RhIG are indicated. >15 mL of Fetal RBC (>30mL fetal whole blood) is consistent with significant fetal maternal hemorrhage. One 300mcg dose of RhIG (RhoGam) protects against 30mL Rh-D positive fetal whole blood or 15ml Rh-D positive fetal RBC. Flow method detects Fetal hemoglobin. Adult HbF (F-cells) may occur in high concentrations in adults with certain inherited conditions. These could interfere with testing. Results should be interpreted with good clinical judgment.
Custom Panel:
No
PRODUCTION SCHEDULE
Turn Around Time:
48 hours
Days Performed:
Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed:
Parkview Regional Medical Center
PHL Test Code:
FMH1
EPIC Test Code:
LAB3284
Alternate Test Names:
Betke-Kleihauer; fetal bleed; Fetal Hemoglobin for Fetal Maternal hemorrhage; Fetal Hgb - KB Test; Fetal Maternal Bleed; Kleihauer-Betke
Included Tests:
% Fetal cells; Volume of hemorrhage; Rhogam (RhIG) Dose (if mother is Rh-Negative)
CPT Coding:
88184