Assessment of Rh Disease by Ratios of Bilirubin to Albumin and Hemopexin to Albumin in Amniotic Fluid

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Abstract
We examined 105 amniotic-fluid samples from 36 Rh-sensitized pregnancies for concentration of bilirubin, protein, albumin and hemopexin (heme-binding beta glycoprotein). Bilirubin measurements obtained spectrophotometrically (Liley method) were compared with levels of total protein, albumin, hemopexin and chemically determined bilirubin. Ratios of the concentrations of chemically assessed bilirubin to albumin reflected most accurately the degree of fetal hemolysis and fetal outcome. A ratio above 0.10 was recorded in eight of 10 patients receiving intrauterine transfusions and in two requiring multiple exchange transfusions. A ratio below 0.05 indicated patients needing no or one transfusion. A rising ratio of hemopexin to albumin in 10 cases usually suggested no or mild involvement; leveling (six cases) and falling ratios (15 cases) were found when exchange or intrauterine transfusions were needed. Inconclusive or negative Liley values were observed in four cases, but ratios of bilirubin and hemopexin to albumin in combination correctly predicted the outcome in three of them.