The treatment of erythroblastosis fetalis with Rh hapten

Abstract

E RYTHROBLASTOSIS fetalis, in its more severe manifestations, still challenges the best of scientific knowledge, and sometimes does not respond to treatment. Many reasonably .successful treatments have been advocated. Wiener,10 Levine,8 DavidsohQ Diamond,” and others have consistently recommended the transfusion of compatible Rhnegative blood into the infant, because the negative blood would not be influenced by the maternal antibodies in the child’s blood stream. Wiener,11 and Wallerstein,g among others, have been successful with simultaneous exsanguination transfusions. This procedure removes the major portion of the child’s Rh-positive dells and replaces them with Rhnegative ones. It is frequently successful, but presents numerous technical difficulties. Darrow and Chapin have advocated the use of compatible Rh-positive blood, on the assumption that favorable results are “due in part to the desensitizing action of the transfused cells, as well as to their oxygen-carrying function.” In the nonanemic cases with highly active hemopoiesis, some workers, such as Cappell,l advocate the withdrawal of some blood preceding transfusion. No method is without serious drawbacks, because of either its inadequacy or the difficulty of timely application. A different approach to the relief of the condition, which might obviate many of the drawbacks of the previous methods of treatment, should be of interest. We here present the treatment of a case of erythroblastosis neonatorum, of the edematous, nonanemic type, by the application of a new approach to the subject. The treatment consisted of injections of an active fraction from Rh-positive blood, the separation of which was recently reported by one of us.2 Mrs. S., the mother of the baby treated, first came under our observation in 1940, when she was admitted to the hospital in the 36th week of pregnancy, with the diagnosis of abruptio placentae and toxemia of pregnancy. She delivered a macerated male fetus and was transfused with 500 cc. Group B blood from her husband. She progressed to recovery without difficulty. The second child, a female, was born in another hospital at the 36th week. A marked icterus was noted on the first pediatric examination. This proved to be progressive. A deoision to transfuse the child was made on the second day of life, but she died before the father could be summoned as a donor. A postmortem examination revealed a marked icterus of the tissues, early pulmonary congestion, very marked enlargement and engorgement of the spleen and liver, with marked hemopoietic activity in the stroma of the organs. The third pregnancy resulted, in February, 1943, again in this hospital, in a girl who is now living and well. Recent. examination of her blood showed her to be Group B, Rh negative. This was the last child by the first husband, who was later killed in service. Ile was Group B, and, by later inference, Rh positive, and heterozygous. The fourth pregnancy resulted in the erythroblastotic baby girl whose treatment is described. The mother had an uneventful pregnancy, except that her delivery was one month beyond the expected date. During her pregnancy, her blood examination showed she is Group B, Rh negative, and, at 32 weeks, showed positive for anti-Rh sensitization with Race’s test and blocking antibodies through a 1:40 dilution. The father was shown to be Group A. His cells were negative to the standard (anti-Rho or anti-D) serum, but were agglutinated by the serum of Mrs. S. Further investigation showed Mr. S. to be an Rh” or cdE type and Mrs. 8.’ serum contained blocking antibodies of anti-Rho (anti-cDe) specificity and agglatinine against Rh” or cdE. (This work was checked by Dr. Philip Levine.) It is probable that tbe first husband provided the stimulus for the formation of anti-Rho (anti-D) blocking anti, bodies.