Erythroblastosis foetalis: Part II

Abstract

Erythroblastosis foetalis type I (hydrops foetalis) has been described in part I, p. 1. Type II. Icterus gravis (26 cases)Maternal and obstetric history, age and sex. The sixteen mothers about whom information was available had had a total of sixty-eight previous pregnancies, an average of 4-3. Thirty-one infants of these pregnancies were stillborn or died in infancy and the cause of death was not stated. Another four infants died with jaundice, apparently icterus gravis. One sibling of the subject in one case, and probably another, had icterus gravis while a third was a stillborn achondroplasiac. In the latter there was excessive haemopoiesis in the liver, but not greater than was found in other achondroplasiac infants. However, there was haemosiderosis of the liver, ferrous and ferric iron impregnation of the capsule and trabeculae of the spleen, and the secretory epithelium of the kidney often gave a diffuse prussian-blue reaction. These changes probably signified erythroblastosis which might have manifested itself as icterus gravis, had the foetus not died in consequence of its deformity. 'The subjects in two cases were siblings. There was evidence that in seven of the sixteen mothers icterus gravis occurred in more than one of their offspring. There was no evidence of a hereditary influence except that the father in one case developed jaundice following influenza fifteen days before the birth of the child.The labours were apparently normal. There was no unusual frequency of albuminuria, oedema or hydramnios in the mothers as in hydrops foetalis.In the twenty-six cases there were sixteen males and ten females. The age varied from two to thirty-five days. The body length varied from 43 to 58 cm. crown-heel. The Bernheim-Karrer (1936-37) the father had been jaundiced. Palm (1919) described the appearance of jaundice in the mother two months before the birth of the child and its continuance into the puerperium. Ritchie (1912-13), Smith (1902) and Dam, Tage-Hansen and Plum (1939) described cases in which the mothers were jaundiced during one pregnancy. Tylecote (1913-14) described jaundice during the mother's eight pregnancies which persisted after her last. Seven of her infants developed jaundice from which only one recovered. Nason (1910) and Rolleston (1910) each described repeated jaundice in the numerous pregnancies of mothers of whose infants many had icterus gravis. Bernheim-Karrer (1936-37) recorded a case in which the mother was always jaundiced and another in which she was jaundiced from time to time and throughout one pregnancy. Hilgenberg (1925), Altzitzoglou (1933), Boehncke (1938 In seventy-four reported cases there were fortytwo males and thirty-two females. These figures and mine show a slight predominance in males. The proportion of full-term pregnancies in reported cases was higher than in hydrops foetalis, although many infants were premature. This is in keeping with a higher average duration of pregnancy in 12