Rh Disease - Wikipedia, The Free Encyclopedia
Content
Rh disease - Wikipedia, the free encyclopedia
1 of 6
http://en.wikipedia.org/wiki/Rh_disease
Rh disease
From Wikipedia, the free encyclopedia
Rh disease (also known as Rhesus isoimmunisation, Rh
Rh disease
(D) disease, Rhesus incompatibility, Rhesus disease, RhD
Hemolytic Disease of the Newborn, Rhesus D Hemolytic
Classification and external resources
Disease of the Newborn or RhD HDN) is one of the causes
ICD-10
P55.0 (http://apps.who.int
of hemolytic disease of the newborn (HDN). The disease
/classifications/icd10/browse
ranges from mild to severe, and typically occurs only in some
/2015/en#/P55.0)
second or subsequent pregnancies of Rh negative women
where the fetus's father is Rh positive, leading to a Rh+
ICD-9
773.0 (http://www.icd9data.com
pregnancy. During birth, the mother may be exposed to the
/getICD9Code.ashx?icd9=773.0)
infant's blood, and this causes the development of antibodies,
MedlinePlus 001600 (http://www.nlm.nih.gov
which may affect the health of subsequent Rh+ pregnancies.
/medlineplus/ency/article
In mild cases, the fetus may have mild anaemia with
/001600.htm)
reticulocytosis. In moderate or severe cases the fetus may
have a more marked anaemia and erythroblastosis
(erythroblastosis fetalis). When the disease is very severe it may cause haemolytic disease of the newborn
(HDN), hydrops fetalis or stillbirth.
Rh disease is generally preventable by treating the mother during pregnancy or soon after delivery with an
intramuscular injection of anti-RhD immunoglobulin (Rho(D) immune globulin). The RhD protein is coded for
by the RHD gene. James Harrison, OAM, also known as the Man with the golden arm, is a blood plasma donor
from Australia whose unusual plasma composition has been used to make a treatment for Rhesus disease. He
has made over 1000 donations throughout his lifetime, and these donations are estimated to have saved over two
million unborn babies from the condition.
Contents
1 Serology
2 Prevention
3 Blood tests
4 Management
5 History of medical advances in Rh disease
6 See also
7 References
8 External links
Serology
During any pregnancy a small amount of the baby's blood can enter the mother's circulation. If the mother is Rh
negative and the baby is Rh positive, the mother produces antibodies (including IgG) against the Rhesus D
antigen on her baby's red blood cells. During this and subsequent pregnancies the IgG is able to pass through
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
2 of 6
http://en.wikipedia.org/wiki/Rh_disease
the placenta into the fetus and if the level of it is sufficient, it will cause destruction of Rhesus D positive fetal
red blood cells leading to the development of Rh disease. It may thus be regarded as insufficient immune
tolerance in pregnancy. Generally Rhesus disease becomes worse with each additional Rhesus incompatible
pregnancy.
The main and most frequent sensitizing event is child birth (about 86% of sensitized cases), but fetal blood may
pass into the maternal circulation earlier during the pregnancy (about 14% of sensitized cases).[1] Sensitizing
events during pregnancy include c-section, miscarriage, therapeutic abortion, amniocentesis, ectopic pregnancy,
abdominal trauma and external cephalic version. However, in many cases there was no apparent sensitizing
event.
The incidence of Rh disease in a population depends on the proportion that are rhesus negative. Many
non-caucasian peoples have a very low proportion who are Rhesus negative, so the incidence of Rh disease is
very low in these populations. In Caucasian populations about 1 in 10 of all pregnancies are of a Rhesus
negative woman with a Rhesus positive baby. It is very rare for the first Rhesus positive baby of a Rhesus
negative woman to be affected by Rh disease. The first pregnancy with a Rhesus positive baby is significant for
a rhesus negative woman because she can be sensitized to the Rh positive antigen. In Caucasian populations
about 13% of Rhesus negative mothers are sensitized by their first pregnancy with a rhesus positive baby. If it
were not for modern prevention and treatment, about 5% of the second Rhesus positive infants of Rhesus
negative women would result in stillbirths or extremely sick babies and many babies who managed to survive
would be severely ill. Even higher disease rates would occur in the 3rd and subsequent Rhesus positive infants
of rhesus negative women. By using anti-RhD immunoglobulin (Rho(D) Immune Globulin) the incidence is
massively reduced.
Rh disease sensitization is about 10 times more likely to occur if the fetus is ABO compatible with the mother
than if the mother and fetus are ABO incompatible.
Prevention
Most Rh disease can be prevented by treating the mother during pregnancy or promptly (within 72 hours) after
childbirth. The mother has an intramuscular injection of anti-Rh antibodies (Rho(D) Immune Globulin), sold
under the brand name RhoGAM. This is done so that the fetal Rhesus D positive erythrocytes are destroyed
before her immune system can discover them. This is passive immunity and the effect of the immunity will
wear off after about 4 to 6 weeks (or longer depending on injected dose) as the anti-Rh antibodies gradually
decline to zero in the maternal blood.
It is part of modern antenatal care to give all Rhesus D negative pregnant women an anti-RhD IgG
immunoglobulin injection at about 28 weeks gestation (with or without a booster at 34 weeks gestation). This
reduces the effect of the vast majority of sensitizing events which mostly occur after 28 weeks gestation.
Anti-RhD immunoglobulin is also given to non-sensitized Rhesus negative women immediately (within 72
hours—the sooner the better) after potentially sensitizing events that occur earlier in pregnancy.
Blood tests
Maternal blood
The Kleihauer–Betke test or flow cytometry on a postnatal maternal blood sample can confirm that fetal
blood has passed into the maternal circulation and can also be used to estimate the amount of fetal blood
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
3 of 6
http://en.wikipedia.org/wiki/Rh_disease
that has passed into the maternal circulation.
The indirect Coombs test is used to screen blood from antenatal women for IgG antibodies that may pass
through the placenta and cause hemolytic disease of the newborn.
Fetal blood (or umbilical cord blood)
The direct Coombs test is used to confirm that the fetus or neonate has an immune mediated hemolytic
anemia.
Full blood count—the hemoglobin level and platelet count are important
Bilirubin (total and indirect)
Management
Antenatal
Serial Ultrasound and Doppler examinations—to detect signs of fetal anemia such as increased blood
flow velocities and monitor hydrops fetalis
Quantitative analysis of maternal anti-RhD antibodies—an increasing level is a sign of fetal Rh disease
Intrauterine blood transfusion
Intraperitoneal transfusion—blood transfused into fetal abdomen
Intravascular transfusion—blood transfused into fetal umbilical vein—This is the method of choice
since the late 1980s, and more effective than intraperitoneal transfusion. A sample of fetal blood
can be taken from the umbilical vein prior to the transfusion.
Early delivery (usually after about 36 weeks gestation)
Postnatal
Phototherapy for neonatal jaundice in mild disease
Exchange transfusion if the neonate has moderate or severe disease (the blood for transfusion must be less
than a week old, Rh negative, ABO compatible with both the fetus and the mother, and be cross matched
against the mothers serum)
History of medical advances in Rh disease
The Rhesus blood type was first discovered in 1937 by Karl Landsteiner and Alexander S. Wiener.[2]
In 1939 Philip Levine and Rufus E. Stetson published their findings about a family who had a stillborn baby
who died of hemolytic disease of the newborn.[3] The mother was aged 25 and it was her second pregnancy and
she suffered blood loss at the delivery. Both parents were blood group O and the husband's blood was used to
give the mother a blood transfusion, but the mother suffered a severe transfusion reaction. They investigated
this transfusion reaction. Since the mother and the father were both blood group O, they concluded that there
must be a previously undiscovered blood group antigen that was present on the husband's RBCs (red blood
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
4 of 6
http://en.wikipedia.org/wiki/Rh_disease
cells) but was not present on the mother's RBCs and that the mother had formed antibodies against the new
blood group antigen. This suggested for the first time that a mother could make blood group antibodies because
of immune sensitization to her fetus's RBCs. They did not name this blood group antigen, but it was
subsequently found to be the Rhesus factor.
The first treatment for Rh disease was an exchange transfusion, which was invented by Alexander S. Wiener.
That procedure was further refined by Harry Wallerstein,[4] a transfusionist. Although the most effective method
of treating the problem at the time, it was only partially ameliorative in cases where damage to the neonate had
already been done. Children with severe motor damage and/or retardation could result. However, it is estimated
that in the two decades it was used approximately 200,000 lives were saved, and the great majority were not
brain damaged.
Ronald Finn, in Liverpool, England applied a microscopic technique for detecting fetal cells in the mother's
blood. It led him to propose that the disease might be prevented by injecting the at-risk mother with an antibody
against fetal red blood cells. He proposed this for the first time to the public on February 18, 1960. A few
months later, he proposed at a meeting of the British Genetical Society that the antibody be anti-RhD.
Nearly simultaneously with him, William Pollack, then of Ortho Pharmaceutical Corporation, and researchers
John Gorman and Vincent Freda of New York City's Columbia-Presbyterian Medical Center,[5] having come to
the same realization, set out to prove it by injecting a group of male prisoners at Sing Sing Correctional Facility
with antibody provided by Ortho, obtained by a fractionation technique developed by Pollack (who also
provided Finn with several vials of antibody during a visit by Finn to Ortho).
Animal studies had previously been conducted by William Pollack, using a rabbit model of Rh. This model,
named the rabbit HgA-F system, was a perfect animal model of human Rh, and enabled Pollack's team to gain
experience in preventing hemolytic disease in rabbits by giving specific HgA antibody, as was later done with
Rh-negative mothers. One of the needs was a dosing experiment that could be used to determine the level of
circulating Rh-positive cells in an Rh-negative pregnant female derived from her Rh-positive fetus. This was
first done in the rabbit system, but subsequent human tests at the University of Manitoba conducted under
Pollack's direction confirmed that this result matched the human dosing perfectly. The dose is 20 µG of
antibody for 1mL of Rh-positive red cells.
Sir William Liley performed the first successful intrauterine transfusion in 1963.
Gorman's sister-in-law was the first at risk woman to receive a prophylactic injection on January 31, 1964.
Clinical trials set up by Pollack in 42 clinical centers in the US, Great Britain, Germany, Sweden, Italy, and
Australia confirmed their hypothesis, and the vaccine was finally approved in England and the United States in
1968. The FDA approved the drug under the name RhoGAM, with a fixed dose of 300 µG, to be given within
three days postpartum. There being no known harm done by delaying the dosage for a week or more after birth,
Ortho asked the FDA to grant permission for it to be given without a postpartum time restriction. In addition,
John M. Bowman, one of the researchers at the University of Manitoba, and Freda pushed to allow antepartum
use. All of this was subsequently granted. Within a year or so, the antibody had been injected with great success
into more than 500,000 women. Time magazine picked it as one of the top ten medical achievements of the
1960s. By 1973, it was estimated that in the US alone, over 50,000 babies' lives had been saved. The use of Rh
immune globulin to prevent the disease in babies of Rh negative mothers has become standard practice, and the
disease, which used to claim the lives of 10,000 babies each year in the US alone, has been virtually eradicated
in the developed world. The achievement was made almost entirely without support from the NIH, who rejected
the New York group's proposal twice. The group got instead only a small grant ($329,765 over 10 years) from
the City of New York. The total cost of the effort was only a couple of million dollars, which is about the cost of
the life-time care of a half-dozen irreparably brain-damaged children. In 1980, Cyril Clarke, Ronald Finn, John
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
5 of 6
http://en.wikipedia.org/wiki/Rh_disease
Gorman, Vincent Freda, and William Pollack each received an Albert Lasker Award for Clinical Medical
Research for their work on Rhesus blood types and the prevention of Rh disease.
Two of the Canadian researchers from the University of Manitoba, Bruce Chown, John M. Bowman and under
the leadership of the President of the Winnipeg Rh Institute, Albert D. Friesen, PhD, licensed a version of the
vaccine, known as WinRho, in 1980. The drug is sold in 35 countries by the Manitoba-based research firm
Cangene, listed on the Toronto Stock Exchange with worth of about $175 million. Cangene was purchased by
the Winnipeg Rh Institute, a facility founded by Chown and Bowman and dedicated to conducting research into
blood related diseases. Chown is honored by the Canadian Medical Hall of Fame for his lifelong work with
erythroblastosis fetalis.
See also
Hemolytic disease of the newborn
Coombs test
Hemolytic anemia
Hematology
Sperm donation
James Harrison
References
1. ^ Bowman, J.; Chown, B.; Lewis, M.; Pollock, J. M. (1978). "Rh-immunization during pregnancy: antenatal
prophylaxis" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1818025). Canadian Med Ass Journal 118 (6):
623–627. PMC 1818025 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1818025).
2. ^ Landsteiner, K.; Weiner, A. (1940). "An Agglutinable Factor in Human Blood Recognized by Immune Sera for
Rhesus Blood". Exp Biol Med 43 (1): 223. doi:10.3181/00379727-43-11151 (http://dx.doi.org
/10.3181%2F00379727-43-11151).
3. ^ Levine, P.; Stetson, R. E. (1939). "An Unusual Case of Intra-group Agglutination". J Am Med Assoc 113 (2):
126–127. doi:10.1001/jama.1939.72800270002007a (http://dx.doi.org/10.1001%2Fjama.1939.72800270002007a).
4. ^ Wallerstein, H. (1946). "Treatment of Severe Erythroblastosis by Simultaneous Removal and Replacement of the
Blood of the Newborn Infant". Science 103 (2680): 583–584. doi:10.1126/science.103.2680.583 (http://dx.doi.org
/10.1126%2Fscience.103.2680.583). PMID 17779885 (https://www.ncbi.nlm.nih.gov/pubmed/17779885).
5. ^ Freda, V.; Gorman, J.; Pollack, W. (1964). "Successful Prevention of Experimental Rh Sensitization in Man with an
Anti-Rh Gamma2-Globulin Antibody Preparation: A Preliminary Report". Transfusion 4 (1): 26–32.
doi:10.1111/j.1537-2995.1964.tb02824.x (http://dx.doi.org/10.1111%2Fj.1537-2995.1964.tb02824.x).
6. Friesen, A.D., Bowman, J.M. and Price, H.W. (1981)J. Appl. Biochem. 3, 164-175
Column Ion Exchange Preparation and C
External links
Green top guidelines for Rh disease prevention 2002 from the RCOG (UK) (http://www.rcog.org.uk
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
6 of 6
http://en.wikipedia.org/wiki/Rh_disease
/index.asp?PageID=512)
National institute of Clinical Excellence (NICE) Guidelines for anti-D prophylaxis
(http://guidance.nice.org.uk/TA156)
"Rh Incompatibility in Pregnancy" by N. Antonios at the Embryo Project Encyclopedia
(http://embryo.asu.edu/handle/10776/2073)
Medical References: Rh Disease (http://www.marchofdimes.org/baby/rh-disease.aspx)
Discovery Health :: All About Rh Disease (http://health.discovery.com/centers/pregnancy/americanbaby
/rhdisease.html)
RH Disease, What causes Rhesus Disease. RH Negative Factor Blood. (http://www.paternityangel.com
/Articles_zone/RHesus/RH1.htm)
A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant
women who are rhesus-negative (http://www.ncchta.org/execsumm/summ704.htm), from the National
Health Service Technology Assessment Programme.
Intrauterine fetal blood transfusion for Rh disease (http://www.webmd.com/baby/intrauterine-fetal-bloodtransfusion-for-rh-disease)
Retrieved from "http://en.wikipedia.org/w/index.php?title=Rh_disease&oldid=633391895"
Categories: Haemorrhagic and haematological disorders of fetus and newborn
Disorders originating in the perinatal period Pediatrics Transfusion medicine Health issues in pregnancy
This page was last modified on 11 November 2014 at 15:37.
Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may
apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered
trademark of the Wikimedia Foundation, Inc., a non-profit organization.
13-01-2015 17:11
1 of 6
http://en.wikipedia.org/wiki/Rh_disease
Rh disease
From Wikipedia, the free encyclopedia
Rh disease (also known as Rhesus isoimmunisation, Rh
Rh disease
(D) disease, Rhesus incompatibility, Rhesus disease, RhD
Hemolytic Disease of the Newborn, Rhesus D Hemolytic
Classification and external resources
Disease of the Newborn or RhD HDN) is one of the causes
ICD-10
P55.0 (http://apps.who.int
of hemolytic disease of the newborn (HDN). The disease
/classifications/icd10/browse
ranges from mild to severe, and typically occurs only in some
/2015/en#/P55.0)
second or subsequent pregnancies of Rh negative women
where the fetus's father is Rh positive, leading to a Rh+
ICD-9
773.0 (http://www.icd9data.com
pregnancy. During birth, the mother may be exposed to the
/getICD9Code.ashx?icd9=773.0)
infant's blood, and this causes the development of antibodies,
MedlinePlus 001600 (http://www.nlm.nih.gov
which may affect the health of subsequent Rh+ pregnancies.
/medlineplus/ency/article
In mild cases, the fetus may have mild anaemia with
/001600.htm)
reticulocytosis. In moderate or severe cases the fetus may
have a more marked anaemia and erythroblastosis
(erythroblastosis fetalis). When the disease is very severe it may cause haemolytic disease of the newborn
(HDN), hydrops fetalis or stillbirth.
Rh disease is generally preventable by treating the mother during pregnancy or soon after delivery with an
intramuscular injection of anti-RhD immunoglobulin (Rho(D) immune globulin). The RhD protein is coded for
by the RHD gene. James Harrison, OAM, also known as the Man with the golden arm, is a blood plasma donor
from Australia whose unusual plasma composition has been used to make a treatment for Rhesus disease. He
has made over 1000 donations throughout his lifetime, and these donations are estimated to have saved over two
million unborn babies from the condition.
Contents
1 Serology
2 Prevention
3 Blood tests
4 Management
5 History of medical advances in Rh disease
6 See also
7 References
8 External links
Serology
During any pregnancy a small amount of the baby's blood can enter the mother's circulation. If the mother is Rh
negative and the baby is Rh positive, the mother produces antibodies (including IgG) against the Rhesus D
antigen on her baby's red blood cells. During this and subsequent pregnancies the IgG is able to pass through
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
2 of 6
http://en.wikipedia.org/wiki/Rh_disease
the placenta into the fetus and if the level of it is sufficient, it will cause destruction of Rhesus D positive fetal
red blood cells leading to the development of Rh disease. It may thus be regarded as insufficient immune
tolerance in pregnancy. Generally Rhesus disease becomes worse with each additional Rhesus incompatible
pregnancy.
The main and most frequent sensitizing event is child birth (about 86% of sensitized cases), but fetal blood may
pass into the maternal circulation earlier during the pregnancy (about 14% of sensitized cases).[1] Sensitizing
events during pregnancy include c-section, miscarriage, therapeutic abortion, amniocentesis, ectopic pregnancy,
abdominal trauma and external cephalic version. However, in many cases there was no apparent sensitizing
event.
The incidence of Rh disease in a population depends on the proportion that are rhesus negative. Many
non-caucasian peoples have a very low proportion who are Rhesus negative, so the incidence of Rh disease is
very low in these populations. In Caucasian populations about 1 in 10 of all pregnancies are of a Rhesus
negative woman with a Rhesus positive baby. It is very rare for the first Rhesus positive baby of a Rhesus
negative woman to be affected by Rh disease. The first pregnancy with a Rhesus positive baby is significant for
a rhesus negative woman because she can be sensitized to the Rh positive antigen. In Caucasian populations
about 13% of Rhesus negative mothers are sensitized by their first pregnancy with a rhesus positive baby. If it
were not for modern prevention and treatment, about 5% of the second Rhesus positive infants of Rhesus
negative women would result in stillbirths or extremely sick babies and many babies who managed to survive
would be severely ill. Even higher disease rates would occur in the 3rd and subsequent Rhesus positive infants
of rhesus negative women. By using anti-RhD immunoglobulin (Rho(D) Immune Globulin) the incidence is
massively reduced.
Rh disease sensitization is about 10 times more likely to occur if the fetus is ABO compatible with the mother
than if the mother and fetus are ABO incompatible.
Prevention
Most Rh disease can be prevented by treating the mother during pregnancy or promptly (within 72 hours) after
childbirth. The mother has an intramuscular injection of anti-Rh antibodies (Rho(D) Immune Globulin), sold
under the brand name RhoGAM. This is done so that the fetal Rhesus D positive erythrocytes are destroyed
before her immune system can discover them. This is passive immunity and the effect of the immunity will
wear off after about 4 to 6 weeks (or longer depending on injected dose) as the anti-Rh antibodies gradually
decline to zero in the maternal blood.
It is part of modern antenatal care to give all Rhesus D negative pregnant women an anti-RhD IgG
immunoglobulin injection at about 28 weeks gestation (with or without a booster at 34 weeks gestation). This
reduces the effect of the vast majority of sensitizing events which mostly occur after 28 weeks gestation.
Anti-RhD immunoglobulin is also given to non-sensitized Rhesus negative women immediately (within 72
hours—the sooner the better) after potentially sensitizing events that occur earlier in pregnancy.
Blood tests
Maternal blood
The Kleihauer–Betke test or flow cytometry on a postnatal maternal blood sample can confirm that fetal
blood has passed into the maternal circulation and can also be used to estimate the amount of fetal blood
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
3 of 6
http://en.wikipedia.org/wiki/Rh_disease
that has passed into the maternal circulation.
The indirect Coombs test is used to screen blood from antenatal women for IgG antibodies that may pass
through the placenta and cause hemolytic disease of the newborn.
Fetal blood (or umbilical cord blood)
The direct Coombs test is used to confirm that the fetus or neonate has an immune mediated hemolytic
anemia.
Full blood count—the hemoglobin level and platelet count are important
Bilirubin (total and indirect)
Management
Antenatal
Serial Ultrasound and Doppler examinations—to detect signs of fetal anemia such as increased blood
flow velocities and monitor hydrops fetalis
Quantitative analysis of maternal anti-RhD antibodies—an increasing level is a sign of fetal Rh disease
Intrauterine blood transfusion
Intraperitoneal transfusion—blood transfused into fetal abdomen
Intravascular transfusion—blood transfused into fetal umbilical vein—This is the method of choice
since the late 1980s, and more effective than intraperitoneal transfusion. A sample of fetal blood
can be taken from the umbilical vein prior to the transfusion.
Early delivery (usually after about 36 weeks gestation)
Postnatal
Phototherapy for neonatal jaundice in mild disease
Exchange transfusion if the neonate has moderate or severe disease (the blood for transfusion must be less
than a week old, Rh negative, ABO compatible with both the fetus and the mother, and be cross matched
against the mothers serum)
History of medical advances in Rh disease
The Rhesus blood type was first discovered in 1937 by Karl Landsteiner and Alexander S. Wiener.[2]
In 1939 Philip Levine and Rufus E. Stetson published their findings about a family who had a stillborn baby
who died of hemolytic disease of the newborn.[3] The mother was aged 25 and it was her second pregnancy and
she suffered blood loss at the delivery. Both parents were blood group O and the husband's blood was used to
give the mother a blood transfusion, but the mother suffered a severe transfusion reaction. They investigated
this transfusion reaction. Since the mother and the father were both blood group O, they concluded that there
must be a previously undiscovered blood group antigen that was present on the husband's RBCs (red blood
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
4 of 6
http://en.wikipedia.org/wiki/Rh_disease
cells) but was not present on the mother's RBCs and that the mother had formed antibodies against the new
blood group antigen. This suggested for the first time that a mother could make blood group antibodies because
of immune sensitization to her fetus's RBCs. They did not name this blood group antigen, but it was
subsequently found to be the Rhesus factor.
The first treatment for Rh disease was an exchange transfusion, which was invented by Alexander S. Wiener.
That procedure was further refined by Harry Wallerstein,[4] a transfusionist. Although the most effective method
of treating the problem at the time, it was only partially ameliorative in cases where damage to the neonate had
already been done. Children with severe motor damage and/or retardation could result. However, it is estimated
that in the two decades it was used approximately 200,000 lives were saved, and the great majority were not
brain damaged.
Ronald Finn, in Liverpool, England applied a microscopic technique for detecting fetal cells in the mother's
blood. It led him to propose that the disease might be prevented by injecting the at-risk mother with an antibody
against fetal red blood cells. He proposed this for the first time to the public on February 18, 1960. A few
months later, he proposed at a meeting of the British Genetical Society that the antibody be anti-RhD.
Nearly simultaneously with him, William Pollack, then of Ortho Pharmaceutical Corporation, and researchers
John Gorman and Vincent Freda of New York City's Columbia-Presbyterian Medical Center,[5] having come to
the same realization, set out to prove it by injecting a group of male prisoners at Sing Sing Correctional Facility
with antibody provided by Ortho, obtained by a fractionation technique developed by Pollack (who also
provided Finn with several vials of antibody during a visit by Finn to Ortho).
Animal studies had previously been conducted by William Pollack, using a rabbit model of Rh. This model,
named the rabbit HgA-F system, was a perfect animal model of human Rh, and enabled Pollack's team to gain
experience in preventing hemolytic disease in rabbits by giving specific HgA antibody, as was later done with
Rh-negative mothers. One of the needs was a dosing experiment that could be used to determine the level of
circulating Rh-positive cells in an Rh-negative pregnant female derived from her Rh-positive fetus. This was
first done in the rabbit system, but subsequent human tests at the University of Manitoba conducted under
Pollack's direction confirmed that this result matched the human dosing perfectly. The dose is 20 µG of
antibody for 1mL of Rh-positive red cells.
Sir William Liley performed the first successful intrauterine transfusion in 1963.
Gorman's sister-in-law was the first at risk woman to receive a prophylactic injection on January 31, 1964.
Clinical trials set up by Pollack in 42 clinical centers in the US, Great Britain, Germany, Sweden, Italy, and
Australia confirmed their hypothesis, and the vaccine was finally approved in England and the United States in
1968. The FDA approved the drug under the name RhoGAM, with a fixed dose of 300 µG, to be given within
three days postpartum. There being no known harm done by delaying the dosage for a week or more after birth,
Ortho asked the FDA to grant permission for it to be given without a postpartum time restriction. In addition,
John M. Bowman, one of the researchers at the University of Manitoba, and Freda pushed to allow antepartum
use. All of this was subsequently granted. Within a year or so, the antibody had been injected with great success
into more than 500,000 women. Time magazine picked it as one of the top ten medical achievements of the
1960s. By 1973, it was estimated that in the US alone, over 50,000 babies' lives had been saved. The use of Rh
immune globulin to prevent the disease in babies of Rh negative mothers has become standard practice, and the
disease, which used to claim the lives of 10,000 babies each year in the US alone, has been virtually eradicated
in the developed world. The achievement was made almost entirely without support from the NIH, who rejected
the New York group's proposal twice. The group got instead only a small grant ($329,765 over 10 years) from
the City of New York. The total cost of the effort was only a couple of million dollars, which is about the cost of
the life-time care of a half-dozen irreparably brain-damaged children. In 1980, Cyril Clarke, Ronald Finn, John
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
5 of 6
http://en.wikipedia.org/wiki/Rh_disease
Gorman, Vincent Freda, and William Pollack each received an Albert Lasker Award for Clinical Medical
Research for their work on Rhesus blood types and the prevention of Rh disease.
Two of the Canadian researchers from the University of Manitoba, Bruce Chown, John M. Bowman and under
the leadership of the President of the Winnipeg Rh Institute, Albert D. Friesen, PhD, licensed a version of the
vaccine, known as WinRho, in 1980. The drug is sold in 35 countries by the Manitoba-based research firm
Cangene, listed on the Toronto Stock Exchange with worth of about $175 million. Cangene was purchased by
the Winnipeg Rh Institute, a facility founded by Chown and Bowman and dedicated to conducting research into
blood related diseases. Chown is honored by the Canadian Medical Hall of Fame for his lifelong work with
erythroblastosis fetalis.
See also
Hemolytic disease of the newborn
Coombs test
Hemolytic anemia
Hematology
Sperm donation
James Harrison
References
1. ^ Bowman, J.; Chown, B.; Lewis, M.; Pollock, J. M. (1978). "Rh-immunization during pregnancy: antenatal
prophylaxis" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1818025). Canadian Med Ass Journal 118 (6):
623–627. PMC 1818025 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1818025).
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External links
Green top guidelines for Rh disease prevention 2002 from the RCOG (UK) (http://www.rcog.org.uk
13-01-2015 17:11
Rh disease - Wikipedia, the free encyclopedia
6 of 6
http://en.wikipedia.org/wiki/Rh_disease
/index.asp?PageID=512)
National institute of Clinical Excellence (NICE) Guidelines for anti-D prophylaxis
(http://guidance.nice.org.uk/TA156)
"Rh Incompatibility in Pregnancy" by N. Antonios at the Embryo Project Encyclopedia
(http://embryo.asu.edu/handle/10776/2073)
Medical References: Rh Disease (http://www.marchofdimes.org/baby/rh-disease.aspx)
Discovery Health :: All About Rh Disease (http://health.discovery.com/centers/pregnancy/americanbaby
/rhdisease.html)
RH Disease, What causes Rhesus Disease. RH Negative Factor Blood. (http://www.paternityangel.com
/Articles_zone/RHesus/RH1.htm)
A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant
women who are rhesus-negative (http://www.ncchta.org/execsumm/summ704.htm), from the National
Health Service Technology Assessment Programme.
Intrauterine fetal blood transfusion for Rh disease (http://www.webmd.com/baby/intrauterine-fetal-bloodtransfusion-for-rh-disease)
Retrieved from "http://en.wikipedia.org/w/index.php?title=Rh_disease&oldid=633391895"
Categories: Haemorrhagic and haematological disorders of fetus and newborn
Disorders originating in the perinatal period Pediatrics Transfusion medicine Health issues in pregnancy
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