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606 NORTH CAROLINA MEDICAL JOURNAL September, 1946 THE CLINICAL IMPORTANCE OF THE RH BLOOD TYPE J. Buren Sidbury, M.D. Wilmington Few medical discoveries have been so fascinating and stimulating as that of the Rh factor. The Rh factor was first recognized in 1940, when Landsteiner and Wiener injected the red blood cells of monkeys into rabbits, and demonstrated that the rabbits developed a substance in their serum which agglutinated a high percentage of human red cells. This substance was designated as the Rh factor because it was a constant finding in the Rhesus monkey's red blood cells. Those human red cells which were agglutinated by this substance were designated Rh-positive; those not agglutinated were Rh-negative. In 1940 Levine demonstrated in the serum of a number of women who had had repeated abortions an antibody similar in action to the antibody produced by the Rh factor. Following this lead, he examined the blood of a number of mothers who had given birth to erythroblastic babies, and found that most of them had this isoagglutinin in their blood and were Rh-negative. The percentage of Rh-negative women in this study was much higher than that in the general population. Seven years earlier — in 1933 — Stetson had reported the case of a young woman who, after five successful pregnancies, had serious transfusion reactions when her husband's blood was used, but none when she was given transfusions from her brothers. In 1942 the army appointed Dr. L. K. Diamond chairman of a committee to investigate transfusion reactions occurring in the armed forces. Many soldiers were having severe transfusion reactions from pooled blood. Most of us are familiar with the magnificent piece of work Dr. Diamond did on this committee. Mode of Development of Hemolytic Anemia of the Newborn The Rh factor is present in the red blood cells of 85 per cent of the white population. It is also said to be present in the liver, Read before the Section on the General Practice of Medicine and Surgery, Medical Society of the State of North Carolina, Pinehur>t. May 3. 1946. From the Babies Hospital, Wilmington, N. C. spleen, kidneys, salivary glands, and body fluids of these individuals. The Rh factor develops in the fetus about the twelfth week —hence its importance in obstetrics. When an Rh-negative woman is pregnant with an Rh-positive fetus, the red cells of the fetus may enter the maternal circulation and stimulate the formation of antigens. The break in continuity of the placenta, which allows fetal red cells to enter the maternal circulation, also allows the mother's serum to enter the baby's circulation. If anti-Rh antigen is present in the mother's serum, it acts on the baby's red cells and produces an antigen-antibody reaction in the baby. The higher the anti-Rh titer, the greater the damage done to the baby. Hemolytic disease of the newborn should be the proper classification for this disease syndrome. Under this heading, erythroblastosis fetalis, hydrops fetalis, and idiopathic anemia without jaundice should be placed. If the Rh-negative mother has not had blood injected previously, either intramuscularly or intravenously, she should have no trouble with her first pregnancy. It is during the first pregnancy with an Rh-positive fetus, however, that the Rh-negative mother becomes sensitized to the Rh factor and develops an anti-Rh antigen which may prevent her from having any more normal babies. If the father is homozygous Rh-posi-tive, the chances are nil that any child of the union will be Rh-negative. If the father is heterozygous Rh-positive, there is a 50-50 chance that the children will be Rh-negative and therefore immune to the anti-Rh antigen in the mother's blood. This information should be obtained by testing the father's blood. Differential Diagnosis When a baby is born with jaundice, anemia, or both, the following conditions must be considered in the differential diagnosis: physiologic jaundice, prematurity, intracranial hemorrhage, hemorrhagic disease of the newborn, hemolytic disease of the newborn, congenital syphilis, sepsis of the newborn, familial acholuric jaundice, and Win-ckel's disease. In icterus gravis of the newborn the jaundice is due to a hemolytic anemia, and is usually associated with an enlarged liver and spleen. The anemia may not be pronounced at birth, but may develop very rapidly, and a fatal termination may occur
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1946 |
Identifier | NCHH-17-007 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 7 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-007.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-007 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 606 |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1946 |
Identifier | NCHH-17-007-0616 |
Form General | Periodicals |
Page Type | all; article; article title |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed71946medi_0616.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 7 |
Issue Number | 11 |
Page Number | 606 |
Health Discipline | Medicine |
Full Text | 606 NORTH CAROLINA MEDICAL JOURNAL September, 1946 THE CLINICAL IMPORTANCE OF THE RH BLOOD TYPE J. Buren Sidbury, M.D. Wilmington Few medical discoveries have been so fascinating and stimulating as that of the Rh factor. The Rh factor was first recognized in 1940, when Landsteiner and Wiener injected the red blood cells of monkeys into rabbits, and demonstrated that the rabbits developed a substance in their serum which agglutinated a high percentage of human red cells. This substance was designated as the Rh factor because it was a constant finding in the Rhesus monkey's red blood cells. Those human red cells which were agglutinated by this substance were designated Rh-positive; those not agglutinated were Rh-negative. In 1940 Levine demonstrated in the serum of a number of women who had had repeated abortions an antibody similar in action to the antibody produced by the Rh factor. Following this lead, he examined the blood of a number of mothers who had given birth to erythroblastic babies, and found that most of them had this isoagglutinin in their blood and were Rh-negative. The percentage of Rh-negative women in this study was much higher than that in the general population. Seven years earlier — in 1933 — Stetson had reported the case of a young woman who, after five successful pregnancies, had serious transfusion reactions when her husband's blood was used, but none when she was given transfusions from her brothers. In 1942 the army appointed Dr. L. K. Diamond chairman of a committee to investigate transfusion reactions occurring in the armed forces. Many soldiers were having severe transfusion reactions from pooled blood. Most of us are familiar with the magnificent piece of work Dr. Diamond did on this committee. Mode of Development of Hemolytic Anemia of the Newborn The Rh factor is present in the red blood cells of 85 per cent of the white population. It is also said to be present in the liver, Read before the Section on the General Practice of Medicine and Surgery, Medical Society of the State of North Carolina, Pinehur>t. May 3. 1946. From the Babies Hospital, Wilmington, N. C. spleen, kidneys, salivary glands, and body fluids of these individuals. The Rh factor develops in the fetus about the twelfth week —hence its importance in obstetrics. When an Rh-negative woman is pregnant with an Rh-positive fetus, the red cells of the fetus may enter the maternal circulation and stimulate the formation of antigens. The break in continuity of the placenta, which allows fetal red cells to enter the maternal circulation, also allows the mother's serum to enter the baby's circulation. If anti-Rh antigen is present in the mother's serum, it acts on the baby's red cells and produces an antigen-antibody reaction in the baby. The higher the anti-Rh titer, the greater the damage done to the baby. Hemolytic disease of the newborn should be the proper classification for this disease syndrome. Under this heading, erythroblastosis fetalis, hydrops fetalis, and idiopathic anemia without jaundice should be placed. If the Rh-negative mother has not had blood injected previously, either intramuscularly or intravenously, she should have no trouble with her first pregnancy. It is during the first pregnancy with an Rh-positive fetus, however, that the Rh-negative mother becomes sensitized to the Rh factor and develops an anti-Rh antigen which may prevent her from having any more normal babies. If the father is homozygous Rh-posi-tive, the chances are nil that any child of the union will be Rh-negative. If the father is heterozygous Rh-positive, there is a 50-50 chance that the children will be Rh-negative and therefore immune to the anti-Rh antigen in the mother's blood. This information should be obtained by testing the father's blood. Differential Diagnosis When a baby is born with jaundice, anemia, or both, the following conditions must be considered in the differential diagnosis: physiologic jaundice, prematurity, intracranial hemorrhage, hemorrhagic disease of the newborn, hemolytic disease of the newborn, congenital syphilis, sepsis of the newborn, familial acholuric jaundice, and Win-ckel's disease. In icterus gravis of the newborn the jaundice is due to a hemolytic anemia, and is usually associated with an enlarged liver and spleen. The anemia may not be pronounced at birth, but may develop very rapidly, and a fatal termination may occur |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-007.pdf |
Document Sort | all; nchh-17 |
Article Title | The Clinical Importance Of The Rh Blood Type |
Article Author | J. Buren Sidbury |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-007 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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