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Accurate estimation of FMH is essential for guiding the dose of Rh immune globulin and mitigating alloimmunization. We conducted a national survey and performed a scoping review to determine the availability, technical characteristics and clinical limitations of FMH tests. We describe the evolution of FMH testing, including the qualitative methods (alpha\u2010fetoprotein level, microscopic weak D test, enzyme\u2010linked antiglobulin test, rosette test, gel agglutination cards) and the quantitative methods (Kleihauer\u2013Betke test, flow cytometry assays). Although the rosette test is the most commonly used qualitative method, it may yield false\u2010negative results with fetal RhD variants or false\u2010positives with maternal RhD variants or a positive direct antiglobulin test. Kleihauer\u2013Betke test is the most commonly used quantitative test but has limitations: It is labour\u2010intensive, prone to interobserver variability and can overestimate FMH when maternal F\u2010cell levels are elevated (e.g. haemoglobinopathies). While modifications to the Kleihauer\u2013Betke test can enhance accuracy, flow cytometry remains the most accurate quantification method. With limitations in flow cytometry availability, efficient sample prioritization and pragmatic referral protocols are required. We propose an algorithm for FMH test selection to support decision\u2010making across clinical contexts and resource settings.<\/jats:p>","DOI":"10.1111\/bjh.20246","type":"journal-article","created":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T00:13:20Z","timestamp":1751674400000},"page":"723-736","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Laboratory assessment of fetomaternal haemorrhage and Rh immune globulin management: Canadian practice and scoping review"],"prefix":"10.1111","volume":"207","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4292-3105","authenticated-orcid":false,"given":"Omar I.","family":"Hajjaj","sequence":"first","affiliation":[{"name":"Department of Medicine Queen's University  Kingston Ontario Canada"},{"name":"Precision Diagnostics and Therapeutics, Sunnybrook Health Sciences Centre  Toronto Ontario 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