ACTH IN THE TREATMENT OF ERYTHROBLASTOSIS

Abstract

Twenty erythroblastotic infants were treated with ACTH. Immediately after delivery 12.5 mg. were given and 6.25 mg. every six hours thereafter for a median period of 8.5 days. These infants showed a delayed adrenal response as measured by a fall in the eosinophile count by the third day. As indicated by the reversal of the Coombs' test there was a sharp drop in the degree of sensitization of red cells in a shorter period than would have been expected naturally. The nucleated cell counts decreased to normal ranges by the fourth day chiefly because of the disappearance of erythroblasts. Red blood cell counts and hemoglobin determinations showed a tendency to rise during the period of ACTH administration and an invariable decrease when ACTH was discontinued. Hemolysis was certainly not completely prevented since most patients became clinically jaundiced and a concurrent rise in serum bilirubin was demonstrable. Four infants who had clinical erythroblastosis without demonstrable antibodies (negative Coombs' test) were treated with ACTH and responded in a similar manner. The Coombs' test became strongly positive in one patient after ACTH was discontinued on the tenth day. Serum bilirubin rose to 12 mg./100 cc. blood and the patient became clinically jaundiced. Fecal urobilinogen increased to 70 mg./24 hours on the fifteenth day. Administration of ACTH was resumed on the seventeenth day followed by a reversal of these processes. Antibiotic therapy was added to the study regime because of the possibility that ACTH may enhance infection in the newborn infant. A peculiar local reaction to pork ACTH was not noted with sheep ACTH. Three patients died, all on the third day. One of these patients was found to have kernicterus at autopsy. No surviving patient has any evidence of kernicterus. A much larger series will be required to demonstrate any effect on the mortality rate of erythroblastosis. Seven infants with mild erythroblastosis were not treated because the potential dangers of ACTH were considered to carry more risk than their state of the disease. Several modifications of the treatment regime used in this study are suggested.