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Anemia
Volume 2013, Article ID 351258, 6 pages
http://dx.doi.org/10.1155/2013/351258
Research Article

Diagnosis of Severe Fetal Anemia Based on Perinatal Outcomes: A Comparative Analysis of the Current Reference Values

1Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Brazil
2Obstetrics and Gynaecology Department, Universidade Federal de Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190, Funcionários, Belo Horizonte, 30.130.100 Minas Gerais, Brazil
3Federal University of Minas Gerais, Brazil

Received 6 July 2013; Revised 22 September 2013; Accepted 22 September 2013

Academic Editor: Bruno Annibale

Copyright © 2013 Zilma Silveira Nogueira Reis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. To compare current criteria for severe fetal anemia diagnosis. Methodology. A cohort study analyzed 105 alloimmunized fetuses that underwent cordocentesis due to risk of anemia. Concordance among the diagnostic criteria for severe fetal anemia, hemoglobin deficit >7 g/dL, hemoglobin deficit ≥5 g/dL, and hemoglobin concentration <0.55 MoM, was analyzed using Cohen’s Kappa index. Perinatal mortality, fetal hydrops, and fetal acidosis were used to discuss discordances. Results. There was fair concordance among the three criteria analyzed: 0.80 (Kappa index, IC 95%: 0.67 to 0.93) when comparing hemoglobin deficit >7.0 g/dL and hemoglobin concentration <0.55 MoM criteria, 0.63 (Kappa index, IC 95%: 0.47 to 0.69) when comparing hemoglobin deficit ≥5.0 g/dL and hemoglobin deficit >7.0 g/dL reference, and 0.77 (Kappa index, IC 95%: 0.64 to 0.90) when comparing hemoglobin deficit≥5.0 g/dL and hemoglobin concentration <0.55 MoM standards. Eighteen cases were classified differently depending on the criteria used. The cut-off point of hemoglobin deficit ≥5 g/dL was the best criterion to discriminate fetuses with poor perinatal outcome in our study. Conclusions. Relevant discordances in classification of severe fetal anemia were pointed out. Some criteria may underestimate the real gravity of fetal anemia.