Results of therapy of erythroblastosis with exchange transfusion.

I N PRE\TIOUS papers' ' 2 , 3 , 4 we described the method of treatment of eryth-roblastosis fetalis with exchange transfusion and presented a few illustrative cases in detail. The purpose of the present paper is to summarize our results in the first i8 cases. The rationale of the therapy of erythroblastosis by exchange transfusion can be hrii fly outlined as follows. According to our concept5-of the pathogenesis of the disease, in the typical case the Rh-positive erythroblastotic baby is born with its red cells coated with " univalent " Rh antibodies, derived from the mother during intrauterine life by transpiacental filtration. In some cases, it is possible that additional Rh antibodies of the " bivalent " type (agglutinins) may he milked into the fetal circulation by the uterine contractions occurring during labor. In any event, the antibodies acting on the infant's red cells may cause them to hemolyze or to clump (by agglutination or conglutination). In cases in which only hemolysis occurs, a hemolytic anemia results which responds to simple transfusions of Rh-negative blood. If intravascular clumping takes place, on the other hand, the circulation to vital organs may become compromised producing the picture of icterus gravis, often terminating with the death of the infant with the postmortem findings of nuclear jaundice and hepatic necrosis. Obviously, such cases will not be benefited by simple transfusion since such therapy cannot reverse the process of red cell clumping. Luckily, intravascular clumping, when it occurs, probably takes place to greatest extent after birth, because in utero the conglutinin content of the fetal plasma is low.8' ''-'#{176} We believe that with the birth of the infant, the conglutinin content may rise to a concentration sufficient to cause clumping of the red cells. The clumping, at first, may be thought of as reversible, the red cells behaving as if they were sticky (" sludged blood, " Knisely "), but in untreated cases, it is probable that the clumping eventually becomes firm, blocking the circulation. If, during the early stages of the disease the infant's blood is drained off and simultaneously replaced with type rh blood of a compatible blood group, it is likely that the disease will become aborted, because type rh blood cells cannot be clumped by the Rh antibodies in the baby's body. From the Blood Transfusion Division and the Department of Pediatrics of the Jewish Hospltal of Brooklyn, N. Y., …