Decrease of serum cholesterol ester in haemolytic disease of the newborn.

The conception of the pathological entity of the three manifestations of haemolytic disease of the newborn: hydrops foetalis, icterus gravis and congenital haemolytic anaemia has been confirmed by the discovery of the Rhesus factor. Moreover, this discovery has allowed us finally to abandon any sharp clinical distinction between the two latter forms of the disease. This is in accord with the fact that icterus may or may not be accompanied by anaemia, while anaemia may occur with or without previous jaundice. There are still, however, many unsolved problems, amongst which the question of liver damage is outstanding. It has long been recognized that the jaundice occurring in haemolytic disease of the newborn cannot be explained as a pure haemolytic icterus. The severity of the jaundice, the positive Van den Bergh reaction and the pathological changes in the liver all point to a toxic injury of the liver. Furthermore, some cases are associated with ' kernikterus ' or with late development of cirrhosis. Gilmour (1944) in his recent work on the morbid anatomy of ' erythroblastosis foetalis ' has discussed the various hepatic changes, and presumed a toxic jaundice due to liver damage. The immunological reactions due to the Rhesus factor which take place in the infant or foetus (reviewed by Taylor and Race, 1944) may afford a partial explanation for the toxic effect upon the liver.