Consultant Haematologist On How Rhesus Incompatibility Can Rob Couples Of The Joy Of Parenthood 

Many people are now aware that genotype compatibility is a defining factor when it comes to choosing a life partner but many are still not clear that it doesn’t just end there.

Many women have suffered repeated miscarriages, still birth or deaths of their newborn among a myriad of other agonising pregnancy and birth complications, the Rhesus factor may be at blame according to a Nigerian Consultant Haematologist who has now shared critical information on Rhesus incompatibility of couples and how to address the problem.

According to the Consultant at the Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Idi-Araba, Prof. Titi Adeyemo, as prevalent as Rhesus Disease is in the country, 19 of every 20 Nigerian has it.

The expert added that rhesus disease is one of the major causes of stillbirths and miscarriages in the country, robbing couples of the joy of parenthood.

She noted that it is a common but serious health condition fuelled by ignorance and myth. Prof. Adeyemo said many children have died due to complications arising from Rhesus incompatibility because their parents are ignorant of their status.

As a precaution against the condition, she urged every young lady and women of childbearing age to submit to blood test to know their rhesus factor in order to avoid lifelong complications during pregnancy.

According to the American College of Obstetrician and Gynecologists, Rhesus factor is a protein that can be found on the surface of red blood cells.

If the protein is present in a person’s blood cells, the individual is rhesus positive, while the absence of it means the person is rhesus negative.

The United Kingdom National Health Service warns that the disease, also known as haemolytic disease of the fetus and newborn, is a condition where antibodies in a pregnant woman’s blood destroy the baby’s blood cells, adding that it poses some risks to both unborn and newborn babies.

Adeyemo, a guest speaker at a webinar hosted by the Rhesus Solution Initiative, a non-governmental organisation, noted that Nigeria has one of the poorest perinatal [relating to the time, usually a number of weeks, immediately before and after birth] statistics in the world, with mortality rates ranging from 36 to 130 per 1,000 live births.

Speaking on the topic, ‘Rhesus Incompatibility, the Myth and the Simple Solution of Awareness’, she warned that a Rh-Negative woman who gives birth to an Rh-Positive baby without taking the necessary medical precaution would have challenges having live babies.

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“With over 700 newborn deaths recorded daily, Nigeria ranks seventh among 10 African countries where newborns have highest risks of dying.

“No doubt, rhesus incompatibility and the consequent rhesus disease contributes to these poor statistics,”

she stated.

The haematologist explained that Rhesus factor is inherited, adding, “It can be passed from either of the parents’ genes to the child. She explained further:

“When a woman is rhesus negative and her foetus is positive, it is called rhesus incompatibility. During pregnancy, the barrier between the mother and foetus is the placenta. Usually, a woman and her baby don’t share blood.

“But sometimes, the blood could mix during delivery. Bleeding during pregnancy, an attempt to manually turn a breached baby or a trauma or injury to the abdomen during pregnancy can also cause the blood to mix.

“When this happens, the blood of an Rh-Negative mother will recognise the Rh-Positive blood from her baby as an invader and will try to destroy it by making rhesus antibodies.

“When this happens, the woman has become sensitised or alloimmunised. These antibodies can cross the placenta and attack the foetus blood cells, leading to stillbirth or death after birth.”

The haematologist also noted that a woman with a history of elective abortion, miscarriage or ectopic pregnancy could have been exposed or sensitised to rhesus positive blood.

Adeyemo pointed out that usually, health problems don’t occur during an Rh-Negative woman’s first pregnancy with an Rh-Positive baby, but that if the Rh immunoglobulin injection is not given immediately after delivery, the woman would continue to make more antibodies that would put the next pregnancy at risk.

“Even in miscarriages as early as the first trimester, induced abortion or ectopic pregnancy, the mother’s immunity is already triggered.

“During pregnancy, a woman who has been alloimmunised through any of these factors will have subsequent pregnancy or her foetus attacked.

“This will cause serious anaemia in the unborn baby as the red blood cells are destroyed faster than the body can replace them.

“The red blood cells carry oxygen and without enough oxygen circulating, the baby could die from anaemia,”

warns the haematologist.

The haematologist noted that rhesus incompatibility is also one of the major causes of jaundice in a newborn.

“The destruction of the red blood cells might vary from mild to severe and fatal. If it is fatal, the baby will die in the womb.

“If it is severe, the baby will be born severely jaundiced and will require blood transfusion to manage or stop the destruction that has already started from the womb.

“Severe jaundice can damage the brain, leading to a condition known as Kernicterus that could cause cerebral palsy, among others,”

she said.

However, the expert says the consequences of rhesus disease can be prevented by stopping a rhesus negative woman from making the antibodies in the first place.

She emphasised that it is almost impossible to manage a woman that becomes alloimmunised or sensitised to the disease.

“The first thing is to find out your rhesus status early in pregnancy or preferably, before pregnancy through a simple blood test.

“If the chances are there, the person is given the Rh immunoglobulin injection.

“During pregnancy, an antibody screen can be done to know if an Rh-Negative woman has already started making antibodies to the Rh-Positive blood of her foetus. This test can also show the level of the antibodies made.

“This can be done during the first trimester, 28 weeks or even more often. And if it is high, the baby would have to be delivered early and kept in an incubator.

“Also, a small number of Rh-Negative women may be exposed to rhesus positive blood cells from the foetus in the last few months of pregnancy and may make antibodies against these cells.

“The injection is given to also prevent them from making the antibodies to safeguard future pregnancy.

“It must be given in the correct amount and within a time frame for it to work properly. Usually within 72 hours after the delivery.

“The treatment is good only for the pregnancy for which it is given and subsequently, a repeat dose is required.”

ALSO READ: Very Important Information On Rhesus Incompatibility Risks By Nigerian Physician, Dr. Atangwho

Recalling her experience as a Rhesus factor patient, convener of the health programme, Mrs. Funmi Banire, said she wanted to, someday, witness the non-existence of rhesus disease in Nigeria.

She noted that being aware of her rhesus negative status early in life was helpful. Mrs Banire said:

“It saved me from what could have resulted in the perpetual sorrow of an inability to carry a healthy pregnancy to term and also from experiencing death of babies.

“This led to the establishment of the Rhesus Solution Initiative.

“Now, not less than five per cent of our estimated 100 million female population, which translates to about five million women, potentially suffers from this affliction.

“Unfortunately, a greater percentage of them are totally ignorant or poor. The resultant effect is that they end up experiencing repeated miscarriages, stillbirths, and neonate deaths.”

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