The Rh Factor and Erythroblastosis Foetalis

Abstract

Recent American work has shown that iso-immunization plays an important part in the aetiology of erythroblastosis foetalis, a familial disease of the newborn, which Parsons, with justification, thinks would be better called " haemolytic disease of the newborn."The part played by iso-immunization in this condition has been described at length by Levine, Burnham, Katzin, and Vogel (1941) and by Boorman, Dodd, and Mollison (1942). In their view, erythroblastosis foetalis results from isoimmunization of the mother to a red-blood-cell antigen present in the foetus, inherited from the father but absent in the mother herself, and the subsequent passage of the mother's immune agglutinins through the placenta to act on the susceptible blood of the foetus. In most cases described by the above authors iso-immunization to the Rh blood-group factor appeared to be responsible, as more than 90% of the mothers were Rh-negative and an antibody to the Rh factor was found in the serum of many of them. The Rh factor is inherited as a dominant character. Whenever it was possible to examine the blood of an erythroblastotic baby of an Rhnegative mother it proved to be Rh-positive. The finding that more than 90% of mothers of erythroblastotic children are Rh-negative when only 15% of the normal population are Rhnegative is in itself so overwhelmingly significant statistically that a connexion between the Rh groups and this disease can hardly be doubted, even apart from the evidence provided by the detection of the antibody in many of the cases.It can be shown that in one pregnancy in ten the mother is Rh-negative and the baby Rh-positive, and that in one pregnancy in five the mother has an agglutinin for an antigen of the A-B--system of groups present in her foetus. Haemolytic disease of the newborn is, however, much rarer than would be expected if iso-immunization and placental transmission of harmful agglutinins from mother to foetus occurred in every instance in which the possibility exists. It is obvious, therefore, that there is yet much to be learned about the way in which iso-immunization operates in such families. The subject is undoubtedly of importance in obstetrics and in pursuit and investigation of human families are in wartime enormously increased. For instance, men and women are away from home in the Forces; travelling is difficult; and, with doctors so fully occupied, personal visiting is practically impossible. Nevertheless, much information has been gathered together, and some of it may well prove of value to future workers. The technique used for detecting the Rh factor and its antibody has been described by Taylor (1943).Results Of the 50 mothers 6 were Rh-positive and 44 were Rhnegative; while in the sera of 38 of these Rh-negative women anti-Rh agglutinins were found. If Rh were not concerned in the causation of erythroblastosis foetalis only 7 or 8 of these 50 women would be expected to be Rh-negative; that 44 were Rh-negative and that Rh antibody was present in the serum of the great majority confirms the conn...

Acute Haemolytic Anaemia due to Sulphonamides

“…The frequency of anti-Rh antibodies arising from pregnancy or transfusion as compared with the rarity of anti-M agglutinins indicates that the Rh factor is usually a better antigen in man than the M substance. Since the children and mother all belong to Group 0 the antigenic qualities of Rh have the optimum conditions in which to exercise their effect, for it is recognized that iso-immunization to the Rh factor is more frequent when the pregnancy is homospecific for ABO groups than when it is hetero-specific (Race, Taylor. Cappell, and McFarlane, 1943;Plaut, Barrow, and Abbott, 1945;Wiener, 1945).…”