Hostile Blood: The Forgotten History of Rh Disease and its Miraculous Cure • The Blood Project
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Nov
27
2023
Hostile Blood: The Forgotten History of Rh Disease and its Miraculous Cure
By Hope Hodge Seck
I never knew my blood type – or even wondered what it was – until my freshman year in college, when I donated as part of a group service project and got a wallet-sized plastic card in the mail from the New York Blood Center. The "B-" symbol displayed in large front on the back of the card meant nothing special to me; I casually mused that I’d rather have had "A+" blood to match the grade point average I spent my nights and weekends striving for. But my roommate Eri, a plainspoken 18-year-old from eastern Europe, had a dark interpretation.
"Your blood is Rh-negative," she said. "That means you’ll die in childbirth."
I laughed in awkward shock. The statement was so absurd and impossible that I couldn’t even bring myself to ask her what the joke was. Surely, there couldn’t be something in my healthy blood that could endanger my dream of becoming a mother. And if there was, I was certain that everyone would know and talk about the existence of this thing.
Indeed, Eri had most of her facts wrong. But I’d later learn that, for most of history, blood type did spell tragedy for women, threatening not their own lives but those of their developing and newborn babies. Blood, the substance closest to life itself with its power to feed and clean the body and fight off infection, turned mothers’ bodies into weapons against their own infants, causing stillbirths, brain damage due to a buildup of bilirubin, severe jaundice and anemia, and swelling around the organs. An estimated 10,000 infants in the U.S. alone once died each year from hemolytic disease of the newborn, once aptly described as a "Shakespearean tragedy" for the way it turns the nurturing environment of the mother’s womb into a threat to the child’s survival.
That’s all now largely a poorly remembered past. Rh-negative women like me are all but guaranteed disease-free pregnancies thanks to a miraculous little injection of Rh immune globulin, often known by its brand name RhoGAM. It’s an "anti-vaccine" that masks or mutes an immune response instead of heightening it, and – in addition to having a flawless safety record – it has been called the most cost-effective drug ever made. Behind the simplicity of this drug, though, is a remarkable story of doctors’ tireless ingenuity; tests on willing inmates in the infamous Sing Sing prison; and crucial gifts of blood plasma – in some cases, for decades – by selfless donors who sought to protect future mothers from the tragedies they’d experienced. The only threat to the cure and its worldwide availability and adoption is the same complacency that led to my own ignorance as a teenage college student nearly 20 years ago.
A Hidden Threat
First, let’s discuss the mystery of mothers’ hostile blood. While about 2 percent of people have my rare B- blood, some 15-18 percent of a given population will have an Rh-negative blood type, meaning their blood lacks the Rh protein, also called the D-antigen, found on the surface of red blood cells. While blood type has essentially no impact on health and typically only matters when coordinating transfusions to ensure donor and recipient are compatible, it becomes critically important when an Rh-negative woman prepares to have children. If her partner has an Rh-positive blood type, she may conceive an Rh-positive child. When blood of mother and child mix – a common occurrence at birth, although it may take place earlier in gestation due to a fall or other trauma – they discover they’re incompatible. That first baby is typically unaffected; but the mother’s blood becomes sensitized with antibodies, a process called alloimmunization. Forever after, her immune response is primed, ready to respond aggressively to foreign blood. Alloimmunized mothers would in the past have a first healthy child, but then lose baby after baby, devastated and mystified by their growing series of tragedies.
For many centuries, Rh disease was just one of many unexplained causes of fetal illness and death. The first known case of Rh incompatibility was diagnosed in 1939. In its first mention of the disease in 1944, the New York Times cited the nascent hope of a cure, saying Rh factor "need not cause infant deaths and childless marriages." Yet nearly a quarter-century later, while my grandmother was still having children, Rh incompatibility remained a disease without a treatment.
As detailed in Julian Guthrie’s excellent book "Good Blood," researchers in separate parts of the world began to near a cure in the late 1950s. They knew they had to neutralize the mother’s immune response before she could become sensitized by the mixing of blood. Dr. John Gorman, an Australian-born physician working in 1958 as a blood bank resident at Columbia Presbyterian...