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Erythroblastosis Fetalis

Overview :

Red blood cells carry several types of proteins, called antigens, on their surfaces. The A, B, and O antigens are used to classify a person's blood as type A, B, AB, or O. Each parent passes one A, B, or O antigen gene to their child. How the genes are paired determines the person's blood type.

A person who inherits an A antigen gene from each parent has type A blood; receiving two B antigen genes corresponds with type B blood; and inheriting A and B antigen genes means a person has type AB blood. If the O antigen gene is inherited from both parents, the child has type O blood; however, the pairing of A and O antigen genes corresponds with type A blood; and if the B antigen gene is matched with the O antigen gene, the person has type B blood.

Another red blood cell antigen, called the Rh factor, also plays a role in describing a person's blood type. A person with at least one copy of the gene for the Rh factor has Rh-positive blood; if no copies are inherited, the person's blood type is Rh-negative. In blood typing, the presence of A, B, and O antigens, plus the presence or absence of the Rh-factor, determine a person's specific blood type, such as A-positive, B-negative, and so on.

A person's blood type has no effect on health. However, an individual's immune system considers only that person's specific blood type, or a close match, acceptable. If a radically different blood type is introduced into the bloodstream, the immune system produces antibodies, proteins that specifically attack and destroy any cell carrying the foreign antigen.

Determining a person's blood type is very important if she becomes pregnant. Blood cells from the unborn baby (fetal red blood cells) can cross over into the mother's bloodstream, especially at delivery. If the mother and her baby have compatible blood types, the crossover does not present any danger. However, if the blood types are incompatible, the mother's immune system manufactures antibodies against the baby's blood.

Usually, this incompatibility is not a factor in a first pregnancy, because few fetal blood cells reach the mother's bloodstream until delivery. The antibodies that form after delivery cannot affect the first child. In later pregnancies, fetuses and babies may be in grave danger. The danger arises from the possibility that the mother's antibodies will attack the fetal red blood cells. If this happens, the fetus or baby can suffer severe health effects and may die.

There are two types of incompatibility diseases: Rh incompatibility disease and ABO incompatibility disease. Both diseases have similar symptoms, but Rh disease is much more severe, because anti-Rh antibodies cross over the placenta more readily than anti-A or anti-B antibodies. (The immune system does not form antibodies against the O antigen.) Therefore, a greater percentage of the baby's blood cells are destroyed by Rh disease.

Both incompatibility diseases are uncommon in the United States due to medical advances over the last 50 years. For example, prior to 1946 (when newborn blood transfusions were introduced) 20,000 babies were affected by Rh disease yearly. Further advances, such as suppressing the mother's antibody response, have reduced the incidence of Rh disease to approximately 4,000 cases per year.

Rh disease only occurs if a mother is Rh-negative and her baby is Rh-positive. For this situation to occur, the baby must inherit the Rh factor gene from the father. Most people are Rh-positive. Only 15% of the Caucasian population is Rh-negative, compared to 5-7% of the African-American population and virtually none of Asian populations.

ABO incompatibility disease is almost always limited to babies with A or B antigens whose mothers have type O blood. Approximately one third of these babies show evidence of the mother's antibodies in their bloodstream, but only a small percentage develop symptoms of ABO incompatibility disease.

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