{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T21:13:31Z","timestamp":1787174011096,"version":"build-2736575974"},"reference-count":25,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Context.\u2014Rh(D)-negative women with a large fetomaternal hemorrhage (FMH) from an Rh(D)-positive fetus are at risk for anti-D alloimmunization if they do not receive adequate Rh immune globulin (RhIG). Determination of the adequate RhIG dose for these women is a critical laboratory procedure for protecting their future Rh(D)-positive children.<\/jats:p>\n                  <jats:p>Objective.\u2014To determine how often laboratories recommended an inaccurate dose of RhIG for excess FMH.<\/jats:p>\n                  <jats:p>Design.\u2014Nearly 1600 laboratories using the College of American Pathologists' proficiency testing for fetal red blood cell detection were surveyed to determine (1) their calculation method and (2) the number of RhIG doses recommended for a survey specimen, based on their measured percentage of fetal red blood cells. We surveyed nearly 1450 laboratories for their accuracy in determining RhIG dose, using 2 common calculation methods we provided.<\/jats:p>\n                  <jats:p>Results.\u2014The AABB Technical Manual method was used by 67% of responding laboratories. However, 20.7% of laboratories using this method would have recommended an inaccurate dose of RhIG\u201411.5% too much and 9.2% too little\u2014for the level of FMH reported in the survey specimen. If all laboratories had used the common recommendation of 300 \u03bcg\/30 mL of fetal blood present, 2% would have recommended RhIG doses too low for the volume of FMH they measured. In 3 of the 4 calculation exercises we provided, 20% to 30% of laboratories underestimated the necessary dose of RhIG.<\/jats:p>\n                  <jats:p>Conclusions.\u2014Based on our surveys, some mothers with excess FMH may be receiving inaccurate doses of RhIG. Laboratories performing quantification of FMH should review their procedures and training for calculating RhIG dosage.<\/jats:p>","DOI":"10.5858\/133.3.465","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T09:34:51Z","timestamp":1613122491000},"page":"465-469","source":"Crossref","is-referenced-by-count":36,"title":["Inaccurate Doses of Rh Immune Globulin After Rh-Incompatible Fetomaternal Hemorrhage: Survey of Laboratory Practice"],"prefix":"10.5858","volume":"133","author":[{"given":"Glenn","family":"Ramsey","sequence":"first","affiliation":[{"name":"From the Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Ill"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","reference":[{"key":"2021021102210138800_i1543-2165-133-3-465-b1","article-title":"Haemolytic disease of the fetus and the newborn."},{"key":"2021021102210138800_i1543-2165-133-3-465-b2","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/j.1423-0410.2007.00945.x","article-title":"Efficacy of RhD monoclonal antibodies in clinical trials as replacement therapy for prophylactic anti-D immunoglobulin: more questions than answers.","volume":"93","author":"Kumpel","year":"2007","journal-title":"Vox Sang"},{"key":"2021021102210138800_i1543-2165-133-3-465-b3","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1046\/j.1537-2995.1982.22683068604.x","article-title":"Detection of fetal-maternal hemorrhage in Rh immune globulin candidates: a rosetting technique using enzyme-treated Rh2Rh2 indicator erythrocytes.","volume":"22","author":"Sebring","year":"1982","journal-title":"Transfusion"},{"key":"2021021102210138800_i1543-2165-133-3-465-b4","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/0002-9378(87)90228-6","article-title":"Clinical high-risk designation does not predict excess fetal-maternal hemorrhage.","volume":"156","author":"Ness","year":"1987","journal-title":"Am J Obstet Gynecol"},{"key":"2021021102210138800_i1543-2165-133-3-465-b5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S0020-7292(99)90000-0","article-title":"ACOG practice bulletin. Prevention of Rh D alloimmunization.","volume":"66","author":"ACOG Committee on Practice Bulletins-Obstetrics.","year":"1999","journal-title":"Int J Gynecol Obstet"},{"key":"2021021102210138800_i1543-2165-133-3-465-b6","article-title":"Use of anti-D immunoglobulin for Rh prophylaxis (22).","author":"Robson"},{"key":"2021021102210138800_i1543-2165-133-3-465-b7","article-title":"Transfusion Medicine Checklist.","author":"Commission on Laboratory Accreditation."},{"key":"2021021102210138800_i1543-2165-133-3-465-b8","article-title":"Standards for Blood Banks and Transfusion Services. 25th ed."},{"key":"2021021102210138800_i1543-2165-133-3-465-b9","article-title":"Surveys 2006. HBF-B. Fetal RBC Detection. Participant Summary.","author":"Transfusion Medicine Resource Committee."},{"key":"2021021102210138800_i1543-2165-133-3-465-b10","article-title":"Perinatal issues in transfusion practice.","author":"Kennedy"},{"key":"2021021102210138800_i1543-2165-133-3-465-b11","article-title":"Surveys 2007. HBF-A. Fetal RBC Detection. Participant Summary.","author":"Transfusion Medicine Resource Committee."},{"key":"2021021102210138800_i1543-2165-133-3-465-b12","article-title":"VassarStats: web site for statistical computation.","author":"Lowry"},{"key":"2021021102210138800_i1543-2165-133-3-465-b13","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.5858\/2000-124-1118-PAPRTW","article-title":"Policies and procedures related to weak D phenotype testing and Rh immune globulin administration: results from supplementary questions to the Comprehensive Transfusion Medicine Survey of the College of American Pathologists.","volume":"124","author":"Domen","year":"2000","journal-title":"Arch Pathol Lab Med"},{"key":"2021021102210138800_i1543-2165-133-3-465-b14","doi-asserted-by":"crossref","first-page":"190","DOI":"10.5858\/2005-129-190-PMODRB","article-title":"Phenotype matching of donor red blood cell units for nonalloimmunized sickle cell disease patients: a survey of 1182 North American laboratories.","volume":"129","author":"Osby","year":"2005","journal-title":"Arch Pathol Lab Med"},{"key":"2021021102210138800_i1543-2165-133-3-465-b15","doi-asserted-by":"crossref","first-page":"981","DOI":"10.5858\/2005-129-981-SATOIA","article-title":"Storage and transfusion of infected autologous blood or components: a survey of North American laboratories.","volume":"129","author":"Shulman","year":"2005","journal-title":"Arch Pathol Lab Med"},{"key":"2021021102210138800_i1543-2165-133-3-465-b16","doi-asserted-by":"crossref","first-page":"984","DOI":"10.5858\/2005-129-984-NAPTPR","article-title":"North American pretransfusion testing practices, 2001\u20132004: results from the College of American Pathologists Interlaboratory Comparison Program Survey data, 2001\u20132004.","volume":"129","author":"Shulman","year":"2005","journal-title":"Arch Pathol Lab Med"},{"key":"2021021102210138800_i1543-2165-133-3-465-b17","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/003693309403900509","article-title":"Implementation of the rhesus prevention programme: a prospective study.","volume":"39","author":"Ghosh","year":"1994","journal-title":"Scott Med J"},{"key":"2021021102210138800_i1543-2165-133-3-465-b18","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/j.1471-0528.1997.tb10646.x","article-title":"Preventing Rhesus D haemolytic disease of the newborn by giving anti-D immunoglobulin: are the guidelines being adequately followed?","volume":"104","author":"Howard","year":"1997","journal-title":"Brit J Obstet Gynaecol"},{"key":"2021021102210138800_i1543-2165-133-3-465-b19","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1080\/01443610050111986","article-title":"Management of women who are Rhesus D negative in Northern Ireland.","volume":"20","author":"Vause","year":"2000","journal-title":"J Obstet Gynaecol"},{"key":"2021021102210138800_i1543-2165-133-3-465-b20","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1046\/j.1537-2995.1991.31491213292.x","article-title":"Detecting fetomaternal hemorrhage: a comparison of five methods.","volume":"31","author":"Bayliss","year":"1991","journal-title":"Transfusion"},{"key":"2021021102210138800_i1543-2165-133-3-465-b21","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/j.1537-2995.2004.03287.x","article-title":"Postdelivery levels of anti-D IgG prophylaxis in D-mothers depend on maternal body weight.","volume":"44","author":"Woelfer","year":"2004","journal-title":"Transfusion"},{"key":"2021021102210138800_i1543-2165-133-3-465-b22","article-title":"Rho(D) Immune Globulin (Human) HyperRHO S\/D Full Dose. 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