Pediatric Hematology Expert Discusses Failure to Diagnose Rhesus Disease in Newborn

This case involves a woman who had been pregnant with her second child without complications for nearly nine months. The patient presented to the hospital after detecting decreased fetal activity, and underwent a battery of blood tests to determine the issue. The patient was then sent home and was advised to return a week later for a routine prenatal visit. The patient claimed that she called defendant later that same evening with complaints of contractions. She stated that defendant advised her to stay home because she would probably be sent home anyway. She further claimed that she called defendant the next morning and immediately went to the hospital after speaking with him. After continued complaints, the patient was seen at the hospital with primary complaints of ongoing contractions and decreased fetal movement. The child was emergently delivered via c-section, at which time he was noted to be pale with decreased reflexes. It was later revealed that one of the tests that the Plaintiff underwent during her first hospital visit, a fetal-maternal hemoglobin screen, had returned positive, yet no follow-up action was taken. After birth, her child was diagnosed with rhesus disease, which allegedly could have been diagnosed and successfully treated with appropriate follow-up of the initial positve test result.

Question(s) For Expert Witness

1. Do you have extensive experience treating rhesus disease?

2. What kind of steps and protocols should be taken after a fetal material hemoglobin screen is taken?

Expert Witness Response E-009555

I have provided hematology care for several NICU babies with hemolytic disease of the newborn. With the use of Rhogam for RHneg mothers, Rh disease has become quite rare. When a baby is born with severe anemia, the fetal-maternal hgb screen (Kleinhauer-Betke test) is only one step in the diagnostic process, in addition to blood typing for the baby and mother, in addition to other tests. The baby's anemia is treated by emergent transfusion (as would be needed in this case) even before these test results are known. Once the results are known, sometimes plasmapheresis or exchange transfusion would be used to remove any maternal antibodies that are lysing the baby's red cells. Again, this is a rare scenario, I have cared for a few babies with hemolytic disease of the newborn, none as severe as this baby.