Intravenous drug abuse causes many health problems. From March 1989 to January 1990 of 27 Rh-negative women (28 pregnancies) referred to our centre, 4 women (5 pregnancies) were Rh immunized due to the sharing of needles and blood with their Rh-positive partners. Severe hydrops was present in 4 of their 5 fetuses when they were first seen at 17-35 weeks of gestation. Only the fetus first seen at 35 weeks survived. That infant was moribund at birth and now has evidence of leukomalacia and porencephaly. The fifth fetus, not hydropic, required two intravascular fetal transfusions in order to survive. A fifth woman, immunized in a similar manner, had a spontaneous abortion. These fetuses represent some of the earliest and severest examples of hydrops fetalis ever seen at our centre. The severity of their fetal hemolytic disease is probably due to the fact that their mothers’ exposure to Rh(D) antigen by blood sharing was continuous and ongoing. Because of their aberrant behaviour, these women have suffered irrreversible reproductive damage.
After 16-32 months in solution at 4°C, ultracentrifuge and immunoelectrophoresis assays of five lots of low protein Rh IgG protein concentrations 3.9, 5.8, 4.1, 3.4 and 3.1%, revealed each lot to consist of a single unaggregated and unfragmented protein with an s20^w constant of 6.5-7.3. The lots were 94.0-98.5% pure IgG. Autoanalyzer studies demonstrated no loss of anti-D for 16-37 months except in one lot stable at 20 months which showed a drop from 363 to 298 μg/ml at 26 months. 125I antiglobulin measurements revealed a 23- to 40-percent early loss of anti-D with stability thereafter. Low protein Rh IgG cleared Rh-positive cells from 11 Rh-negative volunteers and protected 2,093 Rhnegative women at risk of Rh immunization at least as effectively as standard Rh IgG. Low protein Rh IgG is a pure, stable, active, protective and economical agent for use in Rh prophylaxis.
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