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The global burden of Rh disease
  1. Alvin Zipursky1,
  2. Vinod K Paul2
  1. 1Programme for Global Paediatric Research, Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Alvin Zipursky, Programme for Global Paediatric Research, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; alvin.zipursky{at}sickkids.ca

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Rh negative women who deliver an Rh positive baby are at risk of developing anti-Rh antibodies.1 Rh positive babies born of these mothers will develop Rh haemolytic disease. This is a severe condition responsible for death in utero or in the neonatal period or severe jaundice with ensuing brain damage. The natural history of the disease has not been described in recent literature. Walker,1 in 1971, reviewed a series of cases from his community. It was found that 14% of affected pregnancies resulted in stillbirths. Of the survivors, 30% had severe disease almost certainly fatal without treatment, while an additional 30% had moderate disease which would manifest as severe hyperbilirubinaemia that untreated may result in brain damage and/or death. Forty per cent of cases would require no treatment. Therefore, it can be estimated that approximately 50% of children with untreated haemolytic disease of the newborn (HDN) will die of the disease or develop brain damage. Similar observations were made in Manitoba, Canada.2

Over 30 years ago it was established that Rh isoimmunisation could be prevented by passive immunisation with anti-Rh (anti-D) γ globulin.3 4 Thereafter, prevention of Rh disease was instituted using postpartum injections of anti-Rh (anti-D) γ globulin; this has been proven to be highly effective.5

In most developed, high income countries, all Rh negative postpartum women whose babies are Rh positive …

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