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Prevention of Rh-haemolytic disease: results of the clinical trial. A combined study from centres in England and Baltimore.

1966; BMJ; Volume: 2; Issue: 5519 Linguagem: Inglês

10.1136/bmj.2.5519.907

0959-8138

C Clarke, W. T. A. Donohoe, Catherine Durkin, R. Finn, F Path, Rob McConnell, Paul W. Sheppard, D Phil, Shona H. Towers, J. C. Woodrow, C. D. Sheffield, Bradford Leeds, Janet M. Shaw, Ally Speight, L Tovey, Wilma Baltimore, J Bias, J. R. Krevans, A Light-Orr,

Blood groups and transfusion

Finn (1960), in Liverpool, first put forward the idea that it might be possible to prevent immunization of Rh-negative mothers by giving them antibody to destroy Rh-positive foetal cells.The suggestion derived from our earlier work on ABO incompatibility in relation to Rh immunization (Clarke et al., 1958), and the progress of the research since then has been described in four main papers.In the first two (Finn et al., 1961 ; Clarke et al., 1963) we described experiments which were successful in preventing Rh immunization in Rh-negative male volunteers.The basis of the procedure was to remove rapidly from the circulation previously injected chromium-tagged Rh- positive red cells by giving high-titre anti-D as an infusion of plasma.Later Gorman et al. (1963) (see also Freda and Gorman, 1962; Freda et al., 1964) suggested the use of anti-D gamma-globulin instead of plasma, and since then we have used gamma-globulin.In our third paper (Woodrow et al., 1965) we showed that injected Rh-positive foetal cells could be cleared from the cir- culation of Rh-negative women volunteers as effectively as the Rh-positive adult cells were cleared from the Rh-negative men.We also produced evidence to show that the majority of cases of appreciable transplacental haemorrhage occurred during labour or very shortly before it, and, moreover, the greater the number of foetal cells found after delivery the greater was the likelihood of subsequent immunization.In this third paper we also stated that we had begun a clinical trial, in collaboration with colleagues working in Sheffield, Leeds, Bradford, and Baltimore, and the preliminary results of this were reported in August of last year (Clarke and Sheppard, 1965).Subsequently we described experiments which indicated that 1 ml. of gamma- globulin might be as effective in giving protection against the development of antibodies as the 5 ml.which we had used up to then (Clarke et al., 1966).In the present paper we describe the clinical trial, which has demonstrated that, anyhow up to six months after delivery, the technique which was successful in protecting against experi- mental Rh immunization has also protected women from Rh immunization by their Rh-positive foetuses.