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Rh diseaseRh disease (also Rhesus disease, Haemolytic Disease of the Newborn (HDNB) or Morbus haemolyticus neonatorum or erythroblastosis) is a condition that occurs when a Rh negativemother has given birth to a Rh positivebaby and subsequently becomes pregnantwith another Rh positive child. About 5% of at-risk pregnancies would result in still births or extremely sick babies. Many who managed to survive would be severely retarded. Once a woman gives birth to a baby with the disease, all subsequent babies would also have it. The connection between the Rh antigen and erythroblastosiswas made in 1941by Dr. Philip Levine. The treatment that came to be developed for the disease was blood transfusion, which was often ineffective or only partially ameliorative because the damage had already been done. Severely retarded children often resulted. During the first pregnancy and the act of birth a small amount of the baby's bloodmay enter the mother's body. If the mother is Rh negative, her body produces antibodies(including IgG) against the Rhesus antigenson her baby's erythrocytes, if the baby is Rh positive. During the second pregnancy the IgG is able to pass through the placentainto the fetus, where it leads to agglutination and destruction of erythrocytes. Diagnosis is confirmed with a positive Kleihauer test. The means to prevent this harmful disease is to vaccinatethe mother immediately after the birth of her first child: she is treated with anti-Rh antibodies, so that the fetal erythrocytes are destroyed before her immune system can discover them. This explanation of the etiology of the disease was first worked out in 1960by Dr. Ronald Finn, a Liverpool, England native, who applied a microscopic technique for detecting fetal cells in the mother's blood. It lead him to propose that the disease might be prevented by injecting the at-risk mother with an antibody against fetal red blood cells. He proposed this for the first time to the public on February 18, 1960. A few months later, he proposed at a meeting of the British Genetical Society, that the antibody be anti-Rh. Nearly simultaneously with him, a group of researchers from New York City Columbia-Presbyterian Medical Center, John Gorman, Vince Freda, and Bill Pollack came to the same realization, and set out to prove it by injecting a group of male prisoners at Sing Sing Correctional Facilitywith anti-body supplied by Ortho Pharmaceutical Corporation. Dr. Gorman's daughter-in-law was the first at risk woman to receive a prophylactic injection on January 31, 1964. Clinical trials by the two rival groups, and others quickly confirmed their hypothesis, and the vaccine was finally approved in England and the United states in 1968. Within a year or so, it had been injected with great success into more than 500,000 women. Time magazinepicked it as one of the top ten medical achievements of the 1960's. By 1973, it was estimated that in the US alone, over 50,000 babies' lives had been saved. The achievement was made almost entirely without support from the NIH--they rejected the New York group's proposal twice. The group got instead only a small grant ($329,765 over 10 years) from the City of New York. The total cost of the effort was only a couple of million dollars, which is about the cost of the life-time care of a half-dozen irreparably brain-damaged children. None of the discoverers of this great boon to all of mankind got a Nobel, but in 1980, Gorman, Freda, and Pollack each received an Albert Lasker Awardfor Clinical Medical Research. References
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pl:Konflikt serologiczny pt:Eritroblastose fetal
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