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PubMed1985

The concentration of IgG in the serum is a major determinant of Fc-dependent reticuloendothelial function.

Defective Fc receptor-specific reticuloendothelial (RE) function has been reported in certain patients with a variety of immunologic and nonimmunologic diseases. The mechanism responsible for the impaired RE function is uncertain, but it could be caused by immune complexes that are present in many of these disorders. Alternatively, the impaired RE function could be a secondary effect of the high concentrations of monomeric IgG in the serum of these patients, since monomeric IgG can compete with complexed IgG for macrophage receptors in vitro. We studied the Fc-dependent RE function in 30 healthy control subjects and 27 patients using IgG-coated radiolabeled autologous red cells. There was a significant relationship between the concentration of IgG in the serum and the rate of clearance of antibody-sensitized cells (r = 0.51, P less than .01). Patients with hypergammaglobulinemia had the slowest Fc-dependent clearance, whereas those with hypogammaglobulinemia had the most rapid clearance. Immune complexes (Raji or polyethylene glycol) could not be shown to contribute to Fc-dependent RE clearance above the effect of the IgG in the serum. The unusually rapid clearance in a patient with hypogammaglobulinemia could be returned to normal by raising the concentration of IgG in the serum. This study supports the concept that serum (monomeric) IgG competes with immune complexed IgG for macrophage Fc receptors in vivo. The competition for Fc receptors determines the level of competence of Fc-dependent RE function. Based on the results of this study, one can predict that a number of disorders characterized by hypergammaglobulinemia also will have impaired Fc-dependent RE function.

Agammaglobulinemia↗
PubMed1986

The experience and effectiveness of the Nova Scotia Rh program, 1964-84.

A program to reduce the incidence of erythroblastosis fetalis was started in Nova Scotia in 1964. Up to the end of 1984, 120 fetuses received 247 intrauterine transfusions. The survival rate was 45.6% in the first 10 years of the program and 66.7% in the next 11 years. For fetuses at or over 26 weeks' gestation the figures were 51.5% and 73.7% respectively. Postpartum prevention was started in 1968, with administration of Rh immune globulin (RhIG) to Rh-negative unimmunized women within 72 hours after the birth of an Rh-positive infant. Antepartum prevention, started in 1979, consisted of administration of RhIG at 28 weeks' gestation to Rh-negative unimmunized women. The effectiveness of the prevention program was evaluated by enumerating the known cases of Rh(D) alloimmunization in the province from 1982 to 1984: 55 cases were identified, a rate of 1.5 per 1000 births instead of the expected rate of about 10 per 1000.

Blood Transfusion, Intrauterine↗
PubMed1986

Rh0(D) and Du cord blood typing during elective abortion operations.

During dilatation and suction or evacuation abortion operations, the umbilical cord can be delivered and sufficient fetal blood can be sampled to type for the Rho(D) and Du factors in about 30% of cases at 14 menstrual weeks of pregnancy. By 16 weeks, more than 75% can be sampled successfully. When cord blood can be Rh typed, about 40% of the fetuses of Rh negative women were found also to be Rh negative. In these cases, anti-Rho(D) immunoglobulin prophylaxis is unnecessary.

Abortion, Induced↗
PubMed1987

Fifteen years' experience with post-partum Rh prophylaxis in Norway (1969-83): incidence of new cases of anti-D and other clinically important blood group antibodies in pregnant women.

The effect of the post-partum Rh prophylaxis in Norway was studied. From a preprophylaxis incidence of 47.4 new cases of Rh(D) immunization per 10,000 pregnant women the incidence fell to 8.9 per 10,000 in 1982-83, and further to 7.1 per 10,000 in 1986. In the period 1980-83 58 per cent of the new antibodies within the Rh system were anti-D, while 42 per cent had other Rh specificities occurring in Rh(D) positive women. The incidence of new immunizations within the Kell and Duffy systems was also studied. Fifty per cent of the antibodies detected within the three blood group systems occurred in Rh positive gravidae. It is known from other studies that at least 30 per cent of pregnant women who develop blood group antibodies do so after the first assay is performed. Therefore the number of antibodies found in Rh positive women would increase significantly if they too were retested towards the end of pregnancy.

Erythroblastosis, Fetal↗
PubMed1988

Use of Rh positive blood in emergency situations.

The emergency blood needs of 449 patients were met by supplying 1,717 uncrossmatched units of either red blood cells (RBC) type specific Whole Blood or group O RBC. The RBC were all Rh positive, and 601 units were transfused to 262 untyped patients. None of the patients presented with anti-Rh antibodies. Only 20 patients who were Rh negative received group O Rh positive RBC, and most of these patients were male. There were no acute hemolytic reactions or sensitizations of young females. Group O Rh positive RBC is our first choice to support patients with trauma who cannot wait for type specific or crossmatched blood. Those who do survive the emergency conditions can be reverted to blood of their own type without problem. Acceptance of Rh positive emergency transfusions by physicians giving emergency care can prevent unbalanced shortages in a regional blood supply system.

Acute Disease↗
PubMed1988

On the prevention of rhesus immunisation in the RSA.

The utilisation rate of anti-Rh antiserum in South African population groups for the years 1983-1985 was investigated. The number of pregnancies at risk of fetomaternal sensitisation because of Rh incompatibility and hence the number of women requiring prophylactic treatment with anti-Rh anti-serum shortly after delivery can be calculated from the known frequency of Rh-negative subjects in each population group. By relating the number of doses of anti-Rh antiserum actually distributed and used to the number of women requiring this prophylactic treatment, the crude utilisation rate of anti-Rh antiserum is calculated as 41-44% for all population groups combined. The rate for blacks is calculated at 14-20%, for whites 89-94%, for Indians 59-64% and for Coloureds 45-51% (the range of variation covers the years 1983-1985). These figures are discussed in terms of the approximations made for the calculations (hence 'crude utilisation rate'), the experience in other countries (specifically the USA) and the need for improving this facet of primary health care.

Black People↗