8/01/77 Newspaper article from the Virginian-Pilot, Monday:
RH DISEASE: CURE AT LAST
By David Zinman
Washington Post News Service
NEW YORK-Less than a generation ago, Rh disease threatened
the lives of tens of thousands of babies born to parents
with different Rh blood types. Women with Rh negative blood
whose husbands had Rh positive blood were haunted by the
possibility that the biological incompatibility would lead
to death or permanent affliction of their offspring.
But now, nearly all those same parents can have normal,
healthy babies if the parents take appropriate action.
Researchers have developed a safe and effective vaccine.
"I would characterize the clinical use of this (vaccine) as
a genuine medical breakthrough," said Dr. Frederick Miller,
acting chairman of the pathology department of the State
University at Stony Brook, on Long Island.
Amazingly, it took less than 25 years from the time that
scientists discovered the cause of Rh disease in 1939 to
the time when teams of researchers developed the vaccine
in 1961. It was first tested on mothers in 1964 and made
commercially available in 1968.
All human blood is either Rh negative or Rh positive. That
term refers to the absence or presence of the Rh factor - a
protein on the surface of the red blood cell, so named
because scientists first observed it in the rhesus monkey.
Among Caucasians, about 85 per cent have the protein. They
are Rh positive. The other 15 per cent who lack it are Rh
negative. Among blacks, about 95 per cent are Rh positive.
The blood typing of an Rh negative woman becomes important
when she is pregnant and her husband is Rh positive. The
child of such parents can be either Rh negative or Rh
positive. But when the baby is Rh positive, the baby's
life is potentially endangered.
The danger comes from the fact that some of the baby's
"positive" blood enters the mother's "negative" bloodstream
during the birth process. The mother's body defenses then
go to work. In much the same way that her immune system
protects her from disease, it identifies the baby's positive
blood cells as a "foreign" menace and produces antibodies.
There is almost never a threat to the first baby because
its red blood cells usually do not enter the mother's blood
stream, causing the formation of the antibodies, until the
child is leaving the uterus at birth. (The first child of
the Rh incompatible couple is affected less that .5 per cent
of the time.)
But the antibodies become a permanent part of the mother's
blood supply. So if she becomes pregnant again and that
baby is also Rh positive, her antibodies will cross over
to the fetus and attack and destroy the unborn baby's Rh
positive red cells - just as if they were attacking a virus
in the mother's system.
If the baby survives, it will be born an Rh baby, with anemia
or jaundice or brain damage, and requiring extensive medical
care.
In 1961, scientists at the Columbia-Presbyterian Medical
Center here and in Liverpool developed a specially prepared
Rh immune globulin, called RhoGAM, which is injected into an
Rh negative mother within 72 hours after she has delivered
an Rh positive baby. (Possibly, the Rh injection would be
as effective if given at 96 hours, or even a week. But
the first study showed that it works within 72 hours and
no researchers have tested it beyond that time span.)
That Rh vaccine serves as a neutralizer. It prevents the
mother's natural defense system from recognizing the baby's
blood cells now in her own body as foreign. So no antibodies
are produced, and the foreign cells are simply cleared from
her system, passing out through the urine or perspiration,
or are stored in the liver.
Each time she delivers, aborts or miscarries an Rh positive
baby, however, an Rh negative mother must get another
injection of the Rh antibody preparation. If she neglects
to do that, or if she accidentally is transfused with Rh
positive blood (and does not get Rh injections), her
antibodies cannot be neutralized. In such cases, doctors
have to resort to methods used before the discovery of the Rh
vaccine, according to Dr. Jahangir Ayromlooi of Long Island
Jewish-Hillside Medical Center.
Those methods include premature delivery, and even
transfusions to the fetus in the uterus. Sometimes,
transfusions are given right after birth.
Ayromlooi, who heads the division of maternal and fetal
medicine, said that RhoGAM is not absolutely effective.
"There are a few cases where the amount of positive red
blood cells the baby gives the mother is so great that
they will all not be neutralized by one injection of RhoGAM."
But the failure rate - the number of babies born with Rh
disease after the mothers have been injected - is only
between 1 and 1.5 per cent at his hospital. And he says
that reflects national trends.



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