JOURNAL CRITIQUE

Cohort and Section

Date Submitted:
Rotation:
Name: Section:
Assessment of feto-maternal hemorrhage among rhesus D negative pregnant mothers using the kleihauer-betke test (KBT) and
Journal Article Title:
flow cytometry (FCM) in Addis Ababa, Ethiopia

Elements influencing the believability of the research
Writing Style
● Is the report well written – concise, grammatically
correct, avoid the use of jargon? It is well laid out and
organized?
Author
● Do the researcher(s’) qualifications or positions indicate
a degree of knowledge in this particular field?
Report Title
● Is the title clear, accurate, and unambiguous?
Abstract
● Does the abstract offer a clear overview of the study
including the research problem, sample, methodology,
finding, and recommendations?
YES NO Comments and Evidences
The report was organized and well written in such a way that readers can easily
comprehend and grasp the idea of the report especially to those who are familiar
with the topic. The ideas were well-presented as the study was written in a clear
and neat manner. The author provided sufficient details and explanation in the
background of the study and all throughout the report for further understanding.
✔
Headings and subheadings were also used for each part for better navigation on
the paper. Tables and figures were labelled accordingly and are well-presented.
The use of jargon was inevitable since the paper is a medical research which
makes it difficult for general readers to fully understand. Moreover, there were also
no grammatical errors and overall it was well laid out.
The authors’ qualification or positions indicate a degree of knowledge in the
particular field. Fekadu Urgessa came from the Department of Medical Laboratory
Science at Haramaya University in Harar, Ethiopia. He also came from the
Department of Medical Laboratory Science at Addis Ababa University in Ethiopia
along with co-authors, Aster Tsegay and Asaya Birhanu. Meanwhile, Yirgu
Gebrehiwot was part of the Department of Obstetrics and Gynecology at the same
✔
university. Therefore, this implies that the authors have sufficient knowledge with
regards to the topic since one of the courses under the Department of Medical
Laboratory Science is Blood Banking or Immunohematology which is related to the
topic of the study as well as the author who came from the department of obstetrics
and gynecology since it tackles fetomaternal hemorrhage (FMH) among RhD
negative pregnant mothers.

Elements influencing the robustness of the research
Purpose/Research Problem
● Is the purpose of the study or research problem clearly
stated?
YES NO Comments and Evidences
The authors were able to state the purpose of the study. It can be found in the third
✔ up to the last paragraph of the background. They carried out this research study to
be able to enable more effective and less costly prevent RhD alloimmunization; to
implement universal access to appropriate doses of prophylactic anti-D for Rh-
negative pregnant population; and to increase the availability of FMH

Logical Consistency
● Does the research report follow the steps of the
research process in a logical manner?
Literature Review
● Is the review logically organized and offers a balanced
critical analysis of the literature?
Theoretical Framework
● Is there an identified conceptual or theoretical
framework?
● If yes, was it adequately described and is the
framework appropriate?
Aims/Objectives/Research Question/Hypotheses
● Have aims and objectives, a research question or
hypothesis been clearly identified?
● If yes, are they clearly stated and reflect the information
presented in the literature review?
measurements following potentially sensitizing events in Africa.
Steps of the research process involves identifying a research problem, coming up
with an idea or research plan, gathering of data, analyzing the findings, and giving
conclusions. The study was able to show logical consistency following these steps
of the research process. The purpose of the study was aligned with the aims of the
authors which is to assess fetomaternal hemorrhage (FMH) among RhD negative
✔ pregnant mothers, thus, the authors were able to come up with a research plan.
Then they were able to collect data through the samples and techniques used for
FMH determination and analyzed the results through supporting their inferences
from different literature reviews. Finally, the authors came up with the conclusion
based on their findings. With this, logical consistency and coherence were
observed in the study.
✔ The literature review was logically organized and presents a balanced critical
analysis of the literature and the data findings as well. Literature cited in the
background focused mainly on essential information on HDFN, including treatments
such as prophylactic anti-D (RhIG) and RhD immunization. It also includes factors
responsible for perinatal morbidity such as Rh alloimmunization. In the discussion
part of the study, various studies were cited which both prove and refute the claims
of the authors based on their data. It was cited at the discussion that some degree
of fetal-maternal transplacental hemorrhage occurs in 75% of all pregnancies.
Researchers were also cited which were inconsistent with the claims of the authors,
like that of Augustson, et. al., because they concluded that 90.4% of the women
had FMH volume of 1.0 mL or less of Rh D-positive red cells, and 98.5% had a
volume of less than 2.5 mL. It countered the authors’ claim that 92.5% and 87% of
FMH calculated were <10 ml of fetal whole blood (<5 ml fetal RBC) whereas the
remaining 7.5% and 13% were >10 ml of fetal whole blood (>5 ml fetal RBC) for
KBT and FCM methods, respectively.
✔ There was no theoretical framework mentioned in the study, and there was also no
conceptual framework mentioned in the study. These may have been useful to
guide readers to help organize the ideas presented and help summarize the entire
research process that the authors went through.
The aims of the research were clearly identified in the abstract of the paper
wherein it was stated that the study aimed to assess FMH among the RhD
negative mothers through Kleihauer-Betke (KBT) and Flow cytometry (FCM). It was
✔︎
also mentioned that they wanted to determine if patient specific doses of
prophylactic anti-D needed further investigation in Ethiopia and wider Africa. These
objectives support the literature review and background presented.
 The authors were able to mention that the participants were chosen through
Sample/Population convenience sampling. There were a total of 86 blood samples, placed in EDTA
● Has the target population been clearly identified?
test tubes, taken from RhD negative mothers who came in for delivery or
● How were the sample selected? ✔︎
● Is it of adequate size? complications. Although there were no mentions of the breakdown of the inclusion
● Are the inclusion/exclusion criteria clearly identified? and exclusion criteria, 11 samples were excluded as the fetal blood group was
either RhD negative or unknown.
The authors have mentioned in the Samples section of Methods, that the
Ethical Considerations participants of the study have given either a written or oral informed consent prior
● Were the participants fully informed about the nature of
to the test. It was also stated in the study that it was approved by the Ethical and
the research? ✔
● Was the confidentiality of the participants guaranteed? Research Committees of the department of Medical Laboratory Science, Addis
● Was ethical permission granted for the study? Ababa University and reviewed by the research and Ethics committee of the
hospital.
The research design was not explicitly stated. It can only be assumed that the
Study Design
● Is the research design clearly identified?
✔ study is observational, as its goal is only to assess the FMH of RhD negative
mothers using Kleihauer-Betke and Flow cytometry.
Methodology
● Has the data gathering instrument been described and
is it appropriate?

Data Analysis and Results

● Do the conclusions and discussion reflect the
calculated statistics (example: mean, p values, or
confidence intervals)?
● Were the results presented clearly and sufficiently to
enable to draw conclusions?
The authors concluded the study by pointing out that KBT is appropriate for
screening FMH, while FCM is appropriate for accurate quantification and
management of those with large FMH, as well as when the KBT technique fails to
Conclusions detect the presence of maternal hemoglobin F containing cells. This clearly
● Have the authors expressed the effects of an recommends that FCM and KBT shall be used on its appropriate and relevant
intervention or exposure in terms of the likely benefit or
harm which an individual patient can expect?
cases in order to yield efficient and reliable laboratory results.
● Do the authors’ conclusions match the data, analysis,
and statistical significance? Statistical data and results were reiterated in support of the claims of the authors.
Although the results of this study were inconsistent with the results of its
predecessor, it was clearly stated that better sample size might be utilized in future
studies related to
Recommendations
● Was a recommendation for further research made?

Clinical Impact Statement

● What is your perception of the potential impact of the
study on your health care profession, especially on
your practice?

Resources and Refences:

Coughlan, M., Cronin, P., & Ryan, F. (2007). Step-by-step guide to critiquing research. Part 1: quantitative research. British Journal of Nursing (Mark Allen Publishing), 16(11), 658–663.
https://doi.org/10.12968/bjon.2007.16.11.23681

Sullivan. (2008). Critical Appraisal for Research Papers Appraisal Checklist & Guide Questions.
 
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