Kleihauer Test (Blood)

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Auckland Te Toka Tumai

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Kleihauer Test (Blood)

Testing Laboratory

Auckland Te Toka Tumai | Auckland Hospital

Department

Haematology

Delphic Registration Code (Alpha Code)

KLEB

Test Code (Numeric Code)

1481

Laboratory Handling

Phlebotomy

Collect 1x 1ml EDTA blood sample.

Transport

Transport at ambient temperature (8-24°C).

Registration

Blood: KLEB

Amniotic Fluid: KLEA

Sendaway: KLSA

Laboratory

LabPlus Special Haematology

Test Adds Requirement

Only available as test add by Special Haematology.
Flow cytometry is available Monday - Friday during normal working hours.
Send to HWL:

4ml EDTA tube (Lavendar cap)

Minimum volume 1ml EDTA tube (Lavendar cap)

Send at 4°C.

Sample Stability

24 hours at room temperature and 72-hours when refrigerated.

Associated Tests

Kleihauer by Flow Cytometry (Blood)

Synonyms

Fetal Red Cells
FMH

Turnaround Time

1 day

Turnaround Time: Between 5 hours and 1 day URGENT: 5-hours (Requires Haematologist approval). Non-urgent: 1 day Kleihauer testing is batched. Kleihauer batch cut-off times are: 02:00 am 11:30 am 18:30 pm

Specimen Type

Whole Blood

Specimen Requirements

Tube/Container Type:

Preferred

EDTA (Lavender Cap)

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

No of Samples Required

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Pre-testing Requirements

Requests must be made through a specific request form
The form is available on Hippo as a PDF fillable request form (ID 44330) and orderable on FPIM (ID 44329).
For a PDF fillable form please go to Hippo > Forms and Templates > Clinical Forms Library and search for Kleihauer or CC 7654 then download the PDF (use Google Chrome) CC7654 Request Form or access via the Additional Information tab below.

Diagnostic Use

The Kleihauer test gives an indication of the number of fetal cells in the specimen and can be used to detect and quantify fetomaternal haemorrhage (FMH) or more rarely to aid haemoglobinopathy or other studies.
The indications for testing are aligned with the ANZSBT guidelines

GUIDELINES FOR LABORATORY ESTIMATION OF FETOMATERNAL HAEMORRHAGE

The Kleihauer test is used for the following INDICATIONS:
1) To determine the appropriate dose of RhD immunoglobulin for RhD negative women
a) following delivery of RhD positive baby
b) following a sensitising event beyond 20 weeks gestation.
This is not required for women with preformed anti-D alloantibody

2) To assess fetal welfare regardless of RhD status of the mother
a) Persistent decreased fetal movement > 28 weeks gestation AND ultrasound not available within 24h
b) Decreased fetal movements with abnormal CTG and not planning delivery
c) Unexplained fetal hydrops or severe fetal anaemia
d) Near-term fetal death or unexplained stillbirth
3) As part of a haemoglobinopathy screen (see Haemoglobinopathy screen)
4) For detecting and/or confirming the fetal origin of samples collected for further specialised testing

The Kleihauer test is NOT INDICATED for the following:
1) Under 20 weeks (for sensitising events in RhD neg women 1 vial of RhD Ig is sufficient to cover the FMH of a 20-week gestation fetus)
2) Antepartum haemorrhage in RhD+ women
3) Diagnosis of placental abruption
4) Trauma in pregnancy (except for RhD neg women beyond 20 weeks)
5) Evaluation of unexplained abdominal pain in late pregnancy

Interpretation

The identification of red cells containing HbF depends on their resistance to acid-elution of the Hb to a greater extent than normal cells. Treatment of thin, ethanol fixed blood smears in a low pH solution followed by staining in an eosin solution shows the HbF cells to be pink staining in a background of non- staining “ghost” cells.

A loss of 50 mls of blood by the foetus represents a massive haemorrhage. Therefore, the finding of one to three fetal cells per hundred adult cells is evidence of a recent massive transplacental haemorrhage.

Reference Intervals

< 0.05% fetal cells in normal adult blood.

Limitations / Interference

If unfixed slides are stained, all the cells appear as “ghost cells”; including any fetal cells. This will give a false negative result.
Reticulocytes may resemble HbF cells as they also resist acid elution to some extent, but they are usually distinguishable by being much less pink.
Over fixation may partly inhibit elution process giving false positive cells.
The elution process will not be effective if the smear is too thick, adult red cells may not elute properly giving false positive cells.

Uncertainty of Measurement

38%

Last updated: 30/09/2026

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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z #

Testing Laboratory

Department

Delphic Registration Code (Alpha Code)

Test Code (Numeric Code)

Laboratory Handling

Phlebotomy

Transport

Registration

Laboratory

Test Adds Requirement

Sample Stability

Associated Tests

Synonyms

Turnaround Time

Specimen Type

Specimen Requirements

Tube/Container Type:

Preferred

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

No of Samples Required

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Pre-testing Requirements

Aliquot Instructions

Sample Type

Minimum Volume (ml)

Transport to Lab

Additional Referral/Aliquot Information

Diagnostic Use

Interpretation

Reference Intervals

Limitations / Interference

Uncertainty of Measurement

Resources

Contact Information

Enquiry Form

Search tests

Kleihauer Test (Blood)

Overview

Testing Laboratory

Department

Delphic Registration Code (Alpha Code)

Test Code (Numeric Code)

Laboratory Handling

Phlebotomy

Transport

Registration

Laboratory

Test Adds Requirement

Sample Stability

Associated Tests

Synonyms

Turnaround Time

Specimen

Specimen Type

Specimen Requirements

Tube/Container Type:

Preferred

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

No of Samples Required

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Pre-testing Requirements

Referral

Aliquot Instructions

Sample Type

Minimum Volume (ml)

Transport to Lab

Additional Referral/Aliquot Information

Clinical Information/Test Method

Diagnostic Use

Interpretation

Reference Intervals

Limitations / Interference

Uncertainty of Measurement

Additional Information

Resources

Contact Information

Contact Information

Enquiry Form

Search tests