A Case of Massive Fetal-Maternal Hemorrhage: Lessons Learned in Diagnosis and Treatment

Caitlin Raymond, Bradley Grant, Christopher Zahner

Research output: Contribution to journalArticlepeer-review


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 μg 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.

Original languageEnglish (US)
Pages (from-to)333-336
Number of pages4
JournalLab Medicine
Issue number3
StatePublished - May 1 2023


  • Kleihauer-Betke test
  • Rh antigen
  • Rhogam
  • anti-D immunoglobulin
  • massive fetal-maternal hemorrhage

ASJC Scopus subject areas

  • General Medicine


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