THE EVALUATION OF CORD-BLOOD HEMOGLOBIN, RETICULOCYTE PERCENTAGE AND MATERNAL ANTIGLOBULIN TITER IN THE PROGNOSIS OF HEMOLYTIC DISEASE OF THE NEWBORN (ERYTHROBLASTOSIS FETALIS)

Abstract

An unselected series of 218 consecutive pregnant women in whom Rh antibodies were detected by means of a standardized antiglobulin test has been studied to evaluate the prognostic significance of values for cord-blood hemoglobin, reticulocyte percentage and maternal antibody titer at term. Twenty-four of the women gave birth to Rh-negative infants, 35 to stillborn infants, the majority of whom were severely macerated, and 159 to liveborn Rh-positive infants. All but three of the Rh-positive liveborn infants who were not moribund at birth were exchange-transfused if the maternal titer at term was 1:128 or higher. Of the 159 Rh-positive liveborn infants, 19 subsequently died, 5 of these being in the untreated group. The remainder were alive and well at least 1 month after birth. The antibody titer of the maternal serum at term determined by the indirect antiglobulin technique is not quite such a good prognostic index of the chance of survival of liveborn Rh-positive infants as either values for cord-blood hemoglobin or reticulocyte percentage. Titration values of the maternal serum have the distinct advantage that they can be determined before birth, and so give guidance in the management of the case, including the early induction of labor. A statistical comparison of the effectiveness of treatment showed that the lower neonatal death rate achieved in the present series was not significantly different from that in comparable series in England and America. Comparison with results published for a comparable American series, where the prognostic significance of maternal antibody titer at term as determined by the plasma-albumin method was evaluated, suggests that the indirect antiglobulin technique for titrating the antibodies in the maternal serum is not only more sensitive than the plasma-albumin method, but it achieves a more clear-cut separation between mild and severe cases. In consequence the indirect antiglobulin technique gives titration values of greater prognostic significance. Once the child is born, prognosis based on a combination of either maternal antibody titer with values for cord-blood hemoglobin or reticulocyte percentage is more accurate than one based on maternal antibody titer alone.