Rh hemolytic disease. Epidemiologic surveillance in the United States, 1968 to 1975

Nationwide surveillance of Rh hemolytic disease of the newborn showed that associated infant mortality decreased from 941 deaths in 1968 to 269 deaths in 1975, or from 2.7 to 0.9 per 10,000 live births. The incidence of Rh hemolytic disease declined from 45 per 10,000 total births in 1970 to 21 per 10,000 in 1975. In 1970, an estimated 16,000 infants were affected, whereas in 1975, the number was 6,000. Several state-based Rh disease surveillance programs reported declining mortality and incidence and increasing use of Rh immune globulin. Rh immune globulin was administered to an estimated 80% of eligible Rh-negative women in 1974, eighty-one percent in 1975, and 82% in 1976. More concerted efforts are needed to determine the frequency of maternal sensitization and to identify and correct gaps in postpartum and postabortion use of Rh immune globulin.

[Heterologous artificial insemination (author's transl)]

The indications for insemination, the selection of donor, consultation with the recipient parent and the technique will be described, based on our four-year experience. A description of the examination before the insemination and the results from a small collection of cases will be discussed.

[Hemolytic disease of African newborn. Results of a survey conducted at Brazzaville (Congo)]

The authors report one study on the haemolytic disease of african newborn made in Brazzaville (Congo). As in the most of the african countries this disease is not very frequent and it is not very severe. Two cases have been found in two twins, born after the nineth pregnancy. These twins were premature and that can explain the severity of the disease. One of these twins because of his weight which was not impotent died. The immunization in the african wife seems to occur very late, after the fifth pregnancy at least.

Duffy haemolytic disease of the newborn

A case is reported of mild haemolytic disease of the newborn due to anti-Fya (Duffy). This brings to 19 the number of cases of Duffy haemolytic disease recorded in the English literature.

[Fetomaternal rhesus immunization in Algeria]

The frequency and modalities of immunisation in the rhesus system were studied in 847 rhesus negative. Algerian women, and in 247 foreign women. 33% of the Algerian women and 8% of the foreign women were immunised. The high muliparity still frequent in Algeria is one of the causes of this difference. The specificity of the antibodies, the mode of foetal involvement, and the antibody titre in relation to the number of pregnancies and the month of the pregnancy are indicated.

Significance of red-cell irregular antibodies in the obstetric patient

Irregular antibodies were identified in 1.3% of obstetric patients who were delivered at the Royal women's Hospital, Melbourne. The most common antibodies found were anti-P1 and anti-Lewis, but, although these antibodies may cause difficulty in obtaining compatible blood if transfusion is required, they were not associated with haemolytic disease of the newborn. Immunization with other irregular antibodies, especially Rhesus subtype and Kell, may occur due to pregnancy alone or follow the combination of pregnancy and incompatible blood transfusion. Irrespective of the initial cause of immunization, these antibodies are often associated with haemolytic disease of the newborn which may be severe enough to result in perinatal death. As most irregular antibodies are found in patients with Rh-positive blood, the need for screening of all antenatal patients in each pregnancy must be recognized.

Rh isoimmunization, Manitoba, 1963-75

The number of Rh-isoimmunized pregnancies in Manitoba has been reduced from 223 and 228 in the years ending Oct. 31, 1963 and 1964 to 60 and 62 in the years ending Oct. 31, 1974 and 1975. The number per 1000 total births in the same years has decreased from 10.0 and 10.6 to 3.4 and 3.5 Perinatal mortality rates in those years decreased from 13.8 amd 15.7% to 0 and 2.2%, respectively. The number of perinatal deaths has been reduced from 55 in the first 2 years reported to 1 in the last 2 years. Among the 121 isoimmunized women pregnant in the 2-year period ending Oct. 31, 1975, isoimmunization was due to failure to give Rh immune globulin after delivery in 33 and failure to give it during pregnancy in 48. Of the remaining 40, 37 were immunized before Rh immune globulin became available. Complete prevention of Rh isoimmunization and therefore of all perinatal deaths from Rh erythroblastosis can only be achieved through universal Rh testing prenatally and immediately after delivery, and institution of an antenatal Rh prophylaxis program.

Evaluation of different approaches to obstetric care: Part 1

The obstetric management and results obtained by two obstetric teams working in the Cardiff Maternity Hospital over a five-year period are compared. One team had a more active approach to induction of labour and antepartum monitoring with urinary oestrogen assay and serial ultrasound cephalometry than the other. After controlling for differences in the attributes of the two groups of patients treated, it was not possible to show any striking advantage or disadvantage of the more active approach.

Racial difference in incidence of ABO hemolytic disease

In this review of 7,464 consecutive infants born at North Carolina Memorial Hospital, hemolytic disease from ABO incompatibility was found to be two to three times as common in black infants as in white infants. The statistical significance of the difference remained high as more restrictive criteria for ABO hemolytic disease were applied. ABO disease, serious enough to cause an indirect serum bilirubin of 15 mg/100ml or higher, had an incidence in black newborns as great as the incidence of Rh hemolytic disease in whites. In contrast, the general prevalence and severity of hyperbilirubinemia was not found to be higher in black newborns than in white infants. The difference cannot be attributed to differences in the prevalence of ABO blood groups between the two races. Policies of early discharge of newborns could be affected by the finding that ABO erythroblastosis is two to three times as common in black infants as in white infants.

ABO hemolytic disease in Puerto Rico and North Carolina

A prospective study was carried out at the University of Puerto Rico Hospital (UPRH) and at the North Carolina Baptist Hospital (NCBH) in order to establish the incidence of ABO hemolytic disease (ABO HD) in the two populations and to determine the relationship of intestinal parasitic infection of the mother to ABO HD in the infant. The incidence of ABO HD among UPRH at risk pregnancies (type O mother with type A or B infant) was 28.3% or 1 in 3.5 as compared with 18.4% or 1 in 5.4 of NCBH at risk pregnancies (P less than .05). Indirect Coombs' tests in cord sera, representing the passive transfer from mother to fetus of antibodies directed toward antigens on the infants' erythrocytes, were positive in 58.8% of UPRH at risk infants as opposed to 40.4% of NCBH at risk infants (P less than .001). Maternal isohemagglutinin titers at term were higher in type O UPRH mothers than in type O NCBH mothers (P less than .01). A relationship between helminth parasitic infection of the mother and ABO HD in the infant was suspected but not proved.

[Rhesus incompatibility and anti-D prevention in the Düsseldorf region (a ten-year survey) (author's transl)]

Among 116 120 children born between 1964 and 1973, 512 (0.44%) required treatment for haemolytic disease of the newborn caused by the presence of irregular antibodies. While the incidence between 1964 to 1970 ranged between 0.42 to 0.56%, it fell from 1971 to 1973 to 0.28%, evidence for effective anti-D prophylaxis since 1971. Those cases still occurring after 1971 were largely due to pregnancies which had started before 1971. In addition there were abortions, sensitizations during the first pregnancy, but also blood transfusions as cause for new sensitizations. Sensitization after pregnancy despite anti-D prophylaxis was observed twice. In the last few years there has been a relative increase of rare antibodies, increasing the complexities of serological diagnosis. Safety and speed of treatment can be further improved by more frequent identification of irregular antibodies in the mother and regular reports to the paediatrician.

Prevention of rhesus immunization in Australia. The first seven years

After seven years' general use of anti-Rh (D) immunoglobulin in Australia, it is clear that the rate of Rh immunization by pregnancy can be reduced to 1% or less by giving anti-D to women at risk soon after delivery. All Rh-negative women who have miscarriages or terminations of pregnancy should also be given anti-D. The Australian standard dose of 250 mug of anti-D is also much more than the minimum effective dose for most cases, and few more failures would occur if it were reduced to 100mug of antibody. Some of these may be prevented by screening maternal blood for the presence of fetal cells and giving further anti-D when large numbers are found. A trial has been conducted since 1970 to discover whether giving anti-D during pregnancy as well as at delivery will further reduce the rate of rhesus immunization. Results are still inconclusive. While giving anti-D during pregnancy appear to have no serious hazard for mother or infant, it will prevent few cases of rhesus immunization, and may not be justifiable. There has so far been little change in the incidence or mortality of haemolytic disease of the newborn in Australia that cen be attributed to the use of anti-D.

Two years' experience with Rh hemolytic disease reporting

California law, since January 1 1970, has required that all pregnant women, regardless of outcome of delivery, be tested for Rho(D) type, that the mother and physician be notified of the result and that hospitals providing service to newborns report all cases of Rho(D) Hemolytic Disease to the State Department of Public Health. Although there has been only a gradual decrease in the number of deaths due to Rho(D) Hemolytic Disease of the Newborn since 1950, there has been a precipitous fall in the past two years. Since the commencement of reporting of the disease to the State Health Department the number of cases has also dropped dramatically. It is felt that because of our conscientiously administered reporting law the morbidity and mortality figures from HDN in California are accurate, in contrast to results obtained in most other states. It is believed that this report reflects the first really accurate look at a large population for the incidence and mortality from Rho(D) HDN since the advent of widespread use of anti-Rho(D) gamma globulin. Review of the recent literature failed to reveal definitive data on recent incidence and mortality trends for Rho(D) HDN. A survey of state health departments also failed to produce data comparable with California's.A number of factors have played a part in reducing the incidence and mortality from Rho(D) HDN in California-namely, required testing of pregnant women combined with the almost routine use of of anti-Rho(D) immune globulin in eligible women, early recognition and treatment of Rho(D) HDN, and the reduction in family size with an increasing percentage of primiparous mothers.

Rh blood group of grandmother and incidence of erythroblastosis

Maternal red cells may cross the placental barrier and enter the fetal circulation, and this transfer may cause primary sensitization in Rh-negative girls born to Rh-positive mothers. 60 families were studied. Each family consisted of the grandmother, her Rh-negative daughter, and the Rh-positive grandchildren. Only families with ABO compatibility in the three generations, and where the mothers had never been transfused or had never received blood intramuscularly, were selected. The families were divided into 2 groups: the group of the Rh-positive grandmothers, group (+), which consisted of 40 families, and the group of Rh-negative grandmothers, group (-), which consisted of 20 families. The 2 groups were analysed as to the presence of affected grandchildren in any pregnancy. There were 35 (87·5%) affected grandchildren in group (+), and 15 (75%) affected children in group (-). In group (+) the number of mothers with 3 or more Rh-positive pregnancies was 16, and of these, 4 (25%) had only unaffected children. In group (-) 15 mothers had 3 or more Rh-positive pregnancies, and of these, 4 (27%) had only unaffected children. There was a striking similarity in the percentage of affected children between the 1st birth in group (+), 20%, and the 2nd birth in group (-), 20%; the 2nd birth in group (+), 38%, and the 3rd birth in group (-), 30%; the 3rd birth in group (+), 28%, and the 4th birth in group (-), 25%. It was concluded that (1) an Rh-positive grandmother acts similarly to the antigenic stimulation caused by pregnancy and the birth of an Rh-positive fetus; (2) it might be advisable to inject all Rh-negative newborn females, born to Rh-positive mothers, with anti-D γ-globulin, soon after birth; (3) prediction of the risk of erythroblastosis, especially in the case of primigravidae or mothers with one non-affected Rh-positive child, requires the investigation of the blood group of the grandmother on the mother's side.

Should every newborn infant be given a Coombs test?

This report from a community hospital compares the laboratory results with the clinical findings in 1,300 cord blood specimens tested because of potential Rh or ABO mother-child incompati bility, as determined before birth by blood typing of the parents.