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feto-Maternal hemorrhage in Twins, can it affects preferentially

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I recently care of a couple of 34 weeks Mono-Di  twin male infants, one of them with a Hct of 37% and the other 47%. The BW was very similar in both twins at 1890g and 1900g and no h/o olygo was recorded in any of them. I ordered a retic count in the anemic boy, as well as a CUS and a KB test on the mother.

KB test was reported as 0.15; with an estimated of fetal blood loss of 12ml. Retic count was 16% and came down nicely over three days to 8%. Hct remained stable in the low 30%. 

Both kids were asymptomatic since birth and are feeding and growing well.


is this presentation consistent with significant Feto-Maternal Hemorrhage (FMH)?

Can FMH affect preferentially one twin in Monochorionic twin pregnancies?


Mother weight 83kg. I estimated 12ml of fetal blood loss based on the following calculations: maternal blood volume 70ml x weight in kg= 5810ml

plus an increased in 40% of blood volume during pregnancy equals 8134ml. If 0.15% was fetal blood that equals 12.2ml of feto-placental blood loss. If feto-placental blood volume is ~100ml/kg of fetal weight, then 1.890 x100 is 198ml of total feto-placental blood, so 12.2ml represents <5% of the total feto-placental blood volume, which for me does not explain the reticulocytosis or anemia present in this infant, what's your opinion?

thanks for any feedback!


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  • 3 weeks later...

I am currently reading a very interesting article on impact of delayed cord clamping at >30 seconds to 180 seconds vs clamping at <30 seconds of life and at 34 weeks gestation an approximate 40% of the baby's blood volume is held in the placenta. With fast cord clamping and elevation of infant at 60 cm above level of the introitus the baby would have easily lost that blood volume upon clamping if not a little more via venous gravitational flow.

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