Letters, 10/13

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Fetomaternal hemorrhage

I found the fetomaternal hemorrhage article in the August issue (page 1) very interesting. We have had a big push for FMH testing by flow cytometry. As your article says, there isn’t the volume to warrant bringing the test on. Just like your statement that the Kleihauer-Betke test needs competency, the same goes for flow. We have validated the assay, but it is very difficult to validate and it is difficult to be absolutely sure where the gating needs to be on low FMH volumes. If testing is not done frequently enough, the expertise is not there either. There is the problem, too, of not having the test available 24/7 or on the weekends. In addition, it’s very expensive. I think the biggest problem is the reimbursement guidelines—Medicare reimburses about $68 for FMH testing. The flow test alone without any tech time included runs about $200 per test—and that is just the reagents. The reagents expire, so there would be tremendous waste and expense to the lab, for which there is no reimbursement. So, until there can be some guarantee that the lab will get paid for 24/7 flow cytometry staffing and the expensive reagents, there is not going to be much success bringing the test live.

Hanna Uhrova, MT(ASCP), Technical Supervisor,
Hematology/Flow Cytometry Department of Pathology, Texas Children’s Hospital, Houston

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