Rh Blood Group System

Rh blood group system, system for classifying blood groups according to the presence or absence of the Rh antigen, often called the Rh factor, on the cell membranes of the red blood cells (erythrocytes). The designation Rh is derived from the use of the blood of rhesus monkeys in the basic test for determining the presence of the Rh antigen in human blood. The Rh blood group system was discovered in 1940 by Karl Landsteiner and A.S. Weiner. Since that time a number of distinct Rh antigens have been identified, but the first and most common one, called RhD, causes the most severe immune reaction and is the primary determinant of the Rh trait.

The Rh antigen poses a danger for the Rh-negative person, who lacks the antigen, if Rh-positive blood is given in transfusion. Adverse effects may not occur the first time Rh-incompatible blood is given, but the immune system responds to the foreign Rh antigen by producing anti-Rh antibodies. If Rh-positive blood is given again after the antibodies form, they will attack the foreign red blood cells, causing them to clump together, or agglutinate. The resulting hemolysis, or destruction of the red blood cells, causes serious illness and sometimes death.

A similar hazard exists during pregnancy for the Rh-positive offspring of Rh-incompatible parents, when the mother is Rh-negative and the father is Rh-positive. The first child of such parents is usually in no danger unless the mother has acquired anti-Rh antibodies by virtue of incompatible blood transfusion. During labour, however, a small amount of the fetus’s blood may enter the mother’s bloodstream. The mother will then produce anti-Rh antibodies, which will attack any Rh-incompatible fetus in subsequent pregnancies. This process produces erythroblastosis fetalis, or hemolytic disease of the newborn, which can be fatal to the fetus or to the infant shortly after birth. Treatment of erythroblastosis fetalis usually entails one or more exchange transfusions. The disease can be avoided by vaccinating the mother with Rh immunoglobulin after delivery of her firstborn if there is Rh-incompatibility. The Rh vaccine destroys any fetal blood cells before the mother’s immune system can develop antibodies.

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Although the Rh-negative trait is rare in most parts of the world, it occurs in about 15 percent of Caucasians in Europe, Canada, and the United States. The trait’s highest incidence is among the Basques of the Pyrenees (25–35 percent) and the Imazighen (Berbers) of Africa and the Bedouins of the Sinai Peninsula (18–30 percent).