Rhesus Isoimmunization and Therapeutic

SIRy-Mr. W. L. Whitehouse (21 June, p. 759), like myself' and many others, again calls attention to the potential dangers of rhesus isoimmunization in therapeutic abortion. He asks that the extent of this problem be further and scientifically investigated. There are, in fact, one or two further facets to be considered. Firstly, all of us are aware of the numbers of women whose first continuing pregnancy is complicated by rhesus isoimmunization induced by a previous criminal or spontaneous abortion, and it would seem clear that we should include within the scope of an investigation all primigravid women who are aborting, whether this be criminal, spontaneous, or therapeutic. Secondly, it has been claimed in some quarters that different techniques of therapeutic abortion carry different risks of rhesus isoimmunization, and this, in addition, should certainly be investigated. Present stocks of anti-D immune globulin are far too low to allow of routine administration to all Rh-negative nulliparous women undergoing abortion, and it is doubtful if stocks would admit of administration to all such women in whom the Kleihauer test is positive. Up to now, therefore, there has been no clinical indication even to do the Rh test on women admitted with complete septic or spontaneous abortion and certainly not to perform the much more complicated and time-consuming Kleihauer test. I fancy that we are once more up against the problem of the peripheral hospitals with large numbers of cases having to preserve their laboratory facilities for real clinical necessity and the central hospitals with adequate laboratory facilities with small numbers of cases unable to obtain statistically significant data without undue delay.-I am, etc.,