DiagnosisofFMHmayalsobemissedwithABOincompatibility,asfetalcellsarerapidly

clearedfromthematernalcirculationbymaternalantiAorantiBantibodies.Anexampleof
howtoestimatefetalbloodlossbasedontheresultsofaKBstainfollows:

Informationtogather:maternalweight,

maternalhematocrit,
infantweight,
KBstainresults

Assume:averagematernalbloodvolumeis75mL/kgatterm(normaladultblood
volume=60mL/kg);averagefetalplacentalbloodvolumeis120mL/kgatterm
Example:AmothersKBstainresultisreportedas2%.Thismeansthat2%ofthered
cellsonthemothersperipheralsmearcontainHgbF.Ifthemotherweighs75kgandher
hematocritis32%,thenherredcellvolumecanbecalculatedas:

75kg(weight)0.32(hematocrit)75mL/kg(bloodvolume)=1800mL(redcellvolume)
If2%ofthisredcellvolumeisfetal,thentheestimatedfetalredcellmasstransferredintothe
maternalcirculationis1800mL0.02=36mL.
Iftheinfantweighs3kgandhadaprehemorrhagehematocritof45%,thenthefeto
placentalredcellvolumecanbecalculatedas3kg0.45120mL/kg=162mL.
Theinfantwouldthereforehavehemorrhaged36of162mL,or22%,ofitsredcellvolume

intothematernalcirculation.ThiswouldbeconsideredamildtomoderateFMH.Theinfant
mightexhibitsignsofvolumelossifthehemorrhageoccurredacutely.