Haemolytic Disease of the Newborn: A Clinico-Serological Study

Gordon, Ronald R (1947) Haemolytic Disease of the Newborn: A Clinico-Serological Study. MD thesis, University of Glasgow.

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1. The literature on the subject of haemolytic disease of the newborn from 1891 to the present day has been reviewed, 2. A study has been made of 160 cases of this condition admitted to the Royal Hospital for Sick Children, Glasgow from 1934 to November 1946, Twenty-eight of these cases were personally observed during the period of study, 3. One hundred and thirty-two of the cases fell into the category of icterus gravis neonatorum as defined by certain criteria: the remaining 28 belonged to the congenital haemolytic anaemia type of the disease. 4. The clinical features of the disease in the 160 cases have been reviewed and the incidence of Splenomegaly, Biluria and Uribilinuria determined. All cases were jaundiced and/or anaemic. 5. A history of previous stillbirths has been shown to be of some importance in the family history of neonatal jaundice but a history of previous abortions is of none. 6. It has been suggested that the word 'partition' might be adopted to mean the products of conception, whatever their period of gestation. 7. In succeeding pregnancies following a child suffering from haemolytic disease of the newborn, about one quarter of the partitions are unaffected infants and these are produced in about one quarter of the families concerned. 8. Previous blood transfusion was found to be an infrequent cause of Rh sensitisation in mothers of 'affected' infants. 9. There was no increase in the blood non-protein nitrogen in 11 cases; it is concluded that the cause of death in haemolytic disease of the newborn is not the same as in incompatible blood transfusion. 10. The haemorrhagic diathesis in icterus gravis neonatorum and the oedema of hydrops foetalis may be associated with liver dysfunction causing decreased plasma prothrombin and serum proteins respectively. 11. Since the use of Rh-ve blood, the mortality rate in icterus gravis neonatorum has fallen from 52.5% to 32.7%. Some of this drop may have been associated with earlier treatment. 12. The mortality rate in congenital haemolytic anaemia should be nil. 13. The mortality rate in "familial" cases of icterus gravis has not been appreciably lowered by the use of Rh-ve blood. 14. Mental deficiency following icterus gravis neonatorum (kernioterus) was found in four of 31 (12.3%) infants over one year who reported for examination. "Green teeth" were found in 2 of the 31 cases. 15. Kernicterus occurred pathologically in 15 of 52 autopsies (28.8%) performed on cases of icterus gravis neonatorum. 16. Of 81 mothers of 'affected' infants, 77 were found to be Rh-ve and 4 Rh+ve. Antibodies - agglutinating or "incomplete" - were found in the sera of 64 of the 77 Rh-ve mothers. 17. The "conglutination" test of Wiener was found to give a higher number of positive reactions than the ordinary method of detecting agglutinating antibodies. 18. 22 fathers and 64 affected infants were all found to be Rh+ ve. 19. Evidence has been offered to show that incompatibility of blood group between mother and infant protects the mother against Rh sensitisation and may even protect the infant once sensitisation has developed. 20. It is suggested that the jaundice of icterus gravis and the oedema of hydrops foetalis are due to hepatic cell damage caused by pressure atrophy from the excessive erythropoiesis present in the liver. 21. The reason why all Rh-ve women with Rh+ ve husbands do not produce affected infants is because a) There are insufficient pregnancies in some modern families. or b) The father is heterozygous Rh+ve. or c) The infants are of incompatible blood group to the maternal serum. 22. Modern methods of treatment have been discussed and the conclusion has been reached that they are not as satisfactory as was at once hoped they might be. Some form of maternal desensitisation will be the ideal to be aimed at. In the meantime, further experience with exsanguination transfusion is indicated.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine
Date of Award: 1947
Depositing User: Enlighten Team
Unique ID: glathesis:1947-79643
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 04 Mar 2020 16:18
Last Modified: 04 Mar 2020 16:18
URI: https://theses.gla.ac.uk/id/eprint/79643

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