How to manage fetomaternal hemorrhage? Description of five cases and literature review

Alessandra Marciano, Luisa Di Luca, Eugenia Maranella, Emanuela Conte, Cecilia Di Natale, Veronica Pannone, Sandra Di Fabio


Fetomaternal hemorrhage (FMH) is a poorly understood condition in which there is a transfer of fetal blood to the maternal circulation. It occurs in approximately 1-3 per 1,000 births. We described five cases with characteristics suggestive of both acute and chronic anemia. When FMH is suspected, maternal blood can be checked for the presence of fetal red blood cells and usually there are three diagnostic modalities: Kleihauer-Betke test, flow cytometry and Rosette test. The clinical manifestations and the prognosis of FMH depend on the gestational age, the volume of the hemorrhage and the rapidity with which it has occurred. Red blood transfusion is recommended, while in case with severe anemia and cardiac failure an exchange transfusion can be considered. The physician’s awareness of the condition, the ability to suspect and diagnose it with appropriate testing have a significant impact on the epidemiology, accurate management and prognosis for the anemic neonates.


neonatal anemia; fetomaternal hemorrhage; blood transfusion; flow cytometry; exchange transfusion; newborn

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