Use Of Rh Immune Globulin Research Articles

Rh hemolytic disease of the newborn: using incidence observations to evaluate the use of RH immune globulin.

During the 1970s, the crude incidence of Rh hemolytic disease of the newborn (RhHDN) in the United States dropped 65 per cent---from 40.5/10,000 total births in 1970 to 14.3/10,000 total births in 1979. Since the risk of RhHDN is directly associated with birth order, changes both in birth order-specific RhHDN incidence rates and in the birth order distribution would be expected to influence crude RhHDN incidence. Review of birth order-specific incidences ascertained in Connecticut, 1972-1977, shows that incidence was stable for first and second births, whereas it dropped significantly for third and fourth births. Due to the nearly complete use of Rh immune globulin (RhIG) in Connecticut during these years, the drop in these specific rates is best attributed to this prevention strategy. Nationwide, during the 1970s, the annual percentages of fourth and higher order births decreased from 18 per cent to 10 per cent. We estimate that some 30 per cent to 40 per cent of the 1970-1979 drop in the crude rate is attributed to changes in the birth order distribution, whereas 60 per cent to 70 per cent of the drop is attributed to RhIG. However, comparison of pooled incidences for 1972-1974 and 1975-1977 observed in Connecticut for first births and births to 15-19 year olds showed significant increases for both groups in 1975-1977. Further study of specific trends from other areas is needed to confirm these observations. Also needed is investigation of likely causes of sensitization among these teenaged, primiparous women.

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. (JAMA242:1376-1379, 1979)

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.

Additional Uses for Immune Globulin

Dr. Stiehm's review article in Pediatrics (63:301, 1979) is excellent in its comprehensive treatment of the use of immune serum globulin. However, the portion on Rh immune globulin (RhIG) has two omissions regarding current management of the Rh-negative woman: (1) Amniocentesis is an indication for considering the use of RhIG in the Rh-negative pregnant woman, and (2) evidence of massive fetal-maternal hemorrhage (placenta abruptio, placenta previa, or neonatal anemia) in the Rh-negative woman should be cause for an attempt to determine the magnitude of that bleed and gauge the dose of RhIG to the volume of that bleed.

Practical Blood Transfusion

A comparison of the first and second editions outlines many of the changes that have occurred in blood banking between 1969 and 1975. There is a considerable increase in the number of pages devoted to other organizations involved in blood banking. The section on mobile blood drawing has been expanded, discussion of transplantation immunology has been increased, and hepatitis testing, leukophoresis, and the use of Rh immune globulin now all occupy prominent sections. Yet, despite these and other additions, the book has not been greatly enlarged in size, having gone from 383 to 404 pages. A chapter on the practical detection and identification of antibody problems will aid the beginning student. An informative chapter on the production standardization and use of antisera will have great value for the beginner. The discussion of blood groups is complete but not exhaustive. Other books are available that trace the blood groups to their