{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T05:56:38Z","timestamp":1759730198975,"version":"3.37.3"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The use of Rho(D) immune globulin in Rh-negative pregnant women has become standard of care, but many practicing clinicians do not know the dosing recommendations for this essential medication. In this article, we describe a case of a 15-year-old girl who presented with intrauterine fetal demise and was found to have massive fetomaternal hemorrhage. Kleihauer-Betke testing results indicated nearly 460 mL of fetal blood in the maternal circulation. The patient ultimately received 4800 \u00b5g of Rho(D) immune globulin, a dose that required close coordination with the obstetrical service and pharmacy. Although this is an unusual case of large-volume, potentially chronic, fetomaternal hemorrhage, it is also an excellent illustration of the principles for diagnosing this condition, as well as providing dosing guidelines for Rho(D) immunoglobulin to prevent alloimmunization.<\/jats:p>","DOI":"10.1093\/labmed\/lmac116","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T14:55:01Z","timestamp":1667228101000},"page":"333-336","source":"Crossref","is-referenced-by-count":2,"title":["A Case of Massive Fetal-Maternal Hemorrhage: Lessons Learned in Diagnosis and Treatment"],"prefix":"10.1093","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5474-1996","authenticated-orcid":false,"given":"Caitlin","family":"Raymond","sequence":"first","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch , Galveston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch , Galveston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Zahner","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Medical Branch , Galveston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,10,31]]},"reference":[{"issue":"3","key":"2023050216514682000_CIT0001","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1002\/jca.21705","article-title":"Guidelines on the use of therapeutic apheresis in clinical practice\u2014evidence-based approach from the writing committee of the American Society for Apheresis: the Eighth Special Issue","volume":"34","author":"Padmanabhan","year":"2019","journal-title":"J Clin Apher"},{"issue":"12","key":"2023050216514682000_CIT0002","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/BF01481043","article-title":"Demonstration of fetal hemoglobin in erythrocytes of a blood smear [in German]","volume":"35","author":"Kleihauer","year":"1957","journal-title":"Wien Klin Wochenschr"},{"issue":"6","key":"2023050216514682000_CIT0003","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1097\/00000441-195006000-00014","article-title":"Fetal hemoglobin in the human: a review","volume":"219","author":"Lecks","year":"1950","journal-title":"Am J Med Sci"},{"author":"Krywko","key":"2023050216514682000_CIT0004"},{"issue":"4","key":"2023050216514682000_CIT0005","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1002\/ajh.22255","article-title":"Detection of fetomaternal hemorrhage","volume":"87","author":"Kim","year":"2012","journal-title":"Am J Hematology"},{"issue":"3","key":"2023050216514682000_CIT0006","doi-asserted-by":"crossref","first-page":"92","DOI":"10.21307\/immunohematology-2019-208","article-title":"Laboratory methods for Rh immunoprophylaxis: a review","volume":"26","author":"Sandler","year":"2010","journal-title":"Immunohematology"},{"issue":"1","key":"2023050216514682000_CIT0007","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1054\/blre.1999.0123","article-title":"RhD haemolytic disease of the fetus and the newborn","volume":"14","author":"Urbaniak","year":"2000","journal-title":"Blood Rev"},{"issue":"1","key":"2023050216514682000_CIT0008","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/0973-6247.75963","article-title":"Hemolytic disease of the fetus and newborn: current trends and perspectives","volume":"5","author":"Basu","year":"2011","journal-title":"Asian J Transfus Sci"},{"issue":"4","key":"2023050216514682000_CIT0009","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.siny.2008.02.007","article-title":"Fetal anemia due to non-Rhesus-D red-cell alloimmunization","volume":"13","author":"Moise","year":"2008","journal-title":"Semin Fetal Neonatal Med"},{"issue":"6","key":"2023050216514682000_CIT0010","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1097\/00006254-199706000-00022","article-title":"Severe fetomaternal hemorrhage","volume":"52","author":"Giacoia","year":"1997","journal-title":"Obstet Gynecol Surv"},{"issue":"2","key":"2023050216514682000_CIT0011","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1080\/jmf.13.2.128.132","article-title":"Large fetomaternal hemorrhage: clinical presentation and outcome","volume":"13","author":"Kecskes","year":"2003","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"5","key":"2023050216514682000_CIT0012","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1055\/s-2007-994142","article-title":"Massive fetomaternal hemorrhage","volume":"14","author":"Akanli","year":"1997","journal-title":"Am J Perinatol"},{"key":"2023050216514682000_CIT0013","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/B978-0-12-415849-8.00006-5","article-title":"The Blood Group Antigen FactsBook.","volume-title":"The Blood Group Antigen FactsBook","author":"Reid","year":"2012","edition":"3"},{"issue":"1","key":"2023050216514682000_CIT0014","first-page":"40","article-title":"The multiple use of RhoGAM\u00ae*","volume":"65","author":"Keith","year":"1973","journal-title":"J Natl Med Assoc"},{"issue":"2","key":"2023050216514682000_CIT0015","first-page":"130","article-title":"Prevention of Rh hemolytic disease of the newborn","volume":"110","author":"Jennings","year":"1969","journal-title":"Calif Med"},{"issue":"6","key":"2023050216514682000_CIT0016","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1097\/MOH.0b013e32833199ed","article-title":"Mechanisms of anti-D action in the prevention of hemolytic disease of the fetus and newborn: what can we learn from rodent models?","volume":"16","author":"Brinc","year":"2009","journal-title":"Curr Opin Hematol"},{"issue":"4","key":"2023050216514682000_CIT0017","doi-asserted-by":"crossref","first-page":"255","DOI":"10.5455\/msm.2013.25.255-258","article-title":"Occurrence of ABO And RhD incompatibility with Rh negative mothers","volume":"25","author":"Izetbegovic","year":"2013","journal-title":"Materia Sociomed"},{"issue":"4","key":"2023050216514682000_CIT0018","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1111\/j.1748-0361.1989.tb01000.x","article-title":"A subsidized perinatal care program in a rural Colorado county","volume":"5","author":"Main","year":"1989","journal-title":"J Rural Health"},{"issue":"3\u20134","key":"2023050216514682000_CIT0019","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1159\/000263583","article-title":"Fetoplacental blood volume estimation in pregnancies with Rh alloimmunization","volume":"5","author":"Leduc","year":"1990","journal-title":"Fetal Diagn Ther"}],"container-title":["Laboratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/labmed\/article-pdf\/54\/3\/333\/50171199\/lmac116.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/labmed\/article-pdf\/54\/3\/333\/50171199\/lmac116.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T17:01:37Z","timestamp":1683046897000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/labmed\/article\/54\/3\/333\/6782924"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,31]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,10,31]]},"published-print":{"date-parts":[[2023,5,2]]}},"URL":"https:\/\/doi.org\/10.1093\/labmed\/lmac116","relation":{},"ISSN":["0007-5027","1943-7730"],"issn-type":[{"type":"print","value":"0007-5027"},{"type":"electronic","value":"1943-7730"}],"subject":[],"published-other":{"date-parts":[[2023,5,1]]},"published":{"date-parts":[[2022,10,31]]}}}