Transfusion – Antenatal Serology —
Training activity: 6

Details

Perform and interpret results and suggest follow-up testing and clinical management of the patient for feto-maternal haemorrhage (FMH) monitoring

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Considerations

• Use of and interpretation of Kleihauer acid elution test
• Use of and interpretation of results of FMH by flow cytometry
• Dosing calculation including differences in IV and IM delivery
• Relevant guidelines

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What do you already know about feto-maternal haemorrhage (FMH) and the tests used for its monitoring (e.g., Kleihauer-Betke test)?
• What is your understanding of how to interpret FMH results and the subsequent clinical management and follow-up testing required?
• Which laboratory protocols and national guidelines relate to performing and interpreting FMH tests?
• How will you ensure you are proficient in performing the necessary tests? Will you discuss example cases with your training officer to understand the range of possible results and their implications?
• What complexities do you anticipate in interpreting FMH results, particularly in relation to potential sensitising events?
• What challenges might you face in suggesting appropriate follow-up testing and clinical management, and how will you address them?
• How do you feel about this aspect of patient care?

In action

• Pay attention to your actions as you perform the FMH test (e.g., Kleihauer-Betke). How are you ensuring the accuracy and reliability of your technique?
• What decisions are you making as you interpret the results? How are you considering factors that might influence the result?
• How effective are your actions in obtaining a reliable result and interpreting it correctly? Are there any uncertainties in your interpretation?
• What challenges are you facing during the testing process or in determining the clinical significance of the result?
• What can you learn from this specific case regarding FMH monitoring and its implications?
• How does this activity connect to your understanding of potential sensitising events and the need for anti-D prophylaxis?
• Are there alternative methods for FMH detection that you might need to consider if the initial test is inconclusive or if indicated by the clinical context?
• What support or guidance might you need in deciding on appropriate follow-up testing or clinical management based on the FMH result?
• Are you ensuring that your interpretation and suggestions align with current guidelines and your scope of practice?

On action

• What method did you use to perform the FMH test (e.g., Kleihauer-Betke)?
  • What were the key steps? What were the specific results you obtained?
  • What factors did you consider when interpreting the results in the context of potential sensitising events?
  • What follow-up testing or clinical management did you suggest, and what was your reasoning?
  • How did your reflect-in-action during the performance and interpretation influence your final conclusions and recommendations?
• Did you gain a deeper understanding of the technical aspects of the FMH test?
  • Did you learn more about the interpretation of FMH results and their clinical significance?
  • Were there any challenges in performing the test or interpreting the results?
  • What did you learn from these challenges?
  • How did your reflection-in-action shape your understanding of the relationship between FMH and the need for anti-D?
  • How does this experience relate to the requirements for managing potentially sensitising events in post-programme practice?
• What aspects of performing and interpreting FMH results require further development for you?
  • How will you apply the knowledge gained from this experience to future cases involving FMH monitoring?
  • What specific steps will you take to improve your skills in this area, such as reviewing testing protocols or discussing complex cases with senior colleagues?
  • What resources or guidance could further support your learning in FMH monitoring?

Beyond action

• Have you had subsequent opportunities to evaluate and re-evaluate instances where you performed and interpreted FMH monitoring tests (e.g., Kleihauer-Betke test) and suggested follow-up actions?
• Have you compared these experiences with other cases involving potential feto-maternal haemorrhage that you have encountered? What similarities or differences did you observe in the results and management pathways?
• How has this training activity enhanced your technical skills in performing and interpreting tests for feto-maternal haemorrhage?
• Consider how this experience has deepened your understanding of the clinical relevance of FMH in the context of potential sensitising events during pregnancy.
• What transferable skills, such as analytical interpretation, clinical reasoning, and the ability to suggest appropriate next steps, did you strengthen through this training activity that will be crucial in your future role?
• Identify clear actions for continued development in your expertise in FMH monitoring and its clinical implications. How will you stay informed about advancements in testing methodologies and management strategies?

Relevant learning outcomes

#	Outcome
# 1	Outcome Practice in accordance with antenatal serology standards and guidelines.
# 2	Outcome Perform acceptance testing of samples requiring antenatal investigation.
# 3	Outcome Perform and interpret clinical and laboratory investigations to identify cases of haemolytic disease of the fetus or newborn (HDFN).
# 4	Outcome Identify sequential testing algorithms appropriate to the samples under investigation for HDFN.
# 5	Outcome Predict current and future pregnancies at highest risk of HDFN.
# 6	Outcome Identify and advise healthcare professionals on appropriate actions to manage HDFN.
# 7	Outcome Develop management plans including selection of blood components for mother, fetus and neonates during pregnancy.
# 8	Outcome Identify actions required in cases of potentially sensitising events during pregnancy.