Changing the Course of Rh Disease
The UK's National Institute for Clinical Excellence on the cost-effectiveness of detecting and treating RH disease:
"…the benefits of avoiding the burden of early fetal/neonatal loss (including parental grief, the costs of caring for children who have severe brain damage caused by hemolytic disease…, as well as the loss of life years of newborn or stillborn infants) make [treatment with medication] a cost-effective procedure when there is a moderate or high probability that an RhD-negative woman will have a further child or children."
"Guidance on the Use of Routine Antenatal Anti-D Prophylaxis for RhD-Negative Women," Technology Appraisal Guidance, No. 41, May, 2005. |
Lab tests have transformed what was once a major cause of death and disability in newborn children into a medical condition that is now relatively rare.
The condition, known as Rh disease or hemolytic disease, occurs when the blood type of an expectant mother is Rh negative while that of the unborn child is Rh positive. Under these circumstances, the mother's blood cells may develop antibodies that attack the child's blood cells. This can result in anemia, jaundice, heart failure, brain damage, and sometimes the death of a child.
Lab tests for Rh disease allow physicians to identify blood-type differences, which can then be adjusted-for with medication.
- The effect on patient health has been dramatic. In the U.S., Rh disease is now considered to be rare — well down from the 20,000 babies per year affected in the late 1960s. In the UK, deaths dropped from 1 in 2,200 births before the test and medication were available, to 1 in 21,000 births today.
- Rh disease testing and treatment are recommended by the treatment guidelines of public and private sector advisory groups, including the U.S. Preventive Services Task Force.
Lab Tests for Rh Disease:
- Indirect Antiglobulin Test (or Antibody Screen): Detects circulating antibodies that develop in the expectant mothers Rh-negative blood that could attack cells in the unborn baby's Rh-positive blood
- Direct Antiglobulin Test: Detects antibodies that are attached to the red blood cells.
Sources:
- Joseph, KS, "The Decline in Rh Hemolytic Disease: Should Rh Prophylaxis Get All the Credit?", The American Journal of Public Health, Volume 88, Number 2, 209-215, February, 1998.
- "Screening for Rh (D) Incompatibility," U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality.
- "Guidance on the Use of Routine Antenatal Anti-D Prophylaxis for RhD-Negative Women," Technology Appraisal Guidance, No. 41, National Institute of Clinical Excellence, May, 2002.
- Schartz, R, "All About Rh Disease," Discovery Health at http://health.discovery.com/centers/pregnancy/americababy/rhdisease_print.html
- "Lab Tests Online, "Indirect Antiglobulin Test," at http://labtestsonline.org/understanding/analytes/antiglobulin_indirect/multiprint.html
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