Talk:Rh disease

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The phrase Haemolytic disease of the newborn is not specific and includes anti-A, anti-B, RhD, Rhc, RhE, Kell, Kid, Duffy and rarer causes of alloimmune hemolysis in the neonate.

[edit] Phrases I'm not convinced about

"The main and most frequent sensitizing event is child birth (about 86% of sensitized cases), but fetal blood may pass into the maternal circulation earlier during the pregnancy (about 14% of sensitized cases)."

I think that needs citing directly, apart from anything else, I can't see the basis to be so sure of eg 86%. Midgley 20:08, 27 April 2006 (UTC)

I'll look for the reference again. These percentages are for Rh disease and not the other antibody-antgen HDN diseases. Snowman 08:16, 28 April 2006 (UTC)

[edit] Merge?

I agree with the poster at the top - and I wonder if it would be better to merge and redirect. Midgley 20:09, 27 April 2006 (UTC)

I think that hemolytic disease of the newborn (a general term) is so different to Rh disease (a specific disease) that the pages should not be merged. Is is easy to click on the links to change pages, so there is no problem with the pages as they are. If Rh disease was merged then ABO hemolytic disease of the newborn and kell, duffy, kid Rhc RhC Rhe RhE should also be merged, and that would be too much for one page, I think. Snowman 08:16, 28 April 2006 (UTC)

I've not read the others yet, and you may be right, but I suspect there is a huge redundancy in it, and that the different material for each, for an encyclopaedic article, may amount to no more than a paragraph. I know WP is not a hierarchical arrangement, and I've no intention of pressing, but there may be an economy for the reader to be achieved by organising the material as core and differences. The key events are leakage of red cells into the mother, and diffusion of IgG back into a foetus, and it isn't that important which of the molecules triggers the immune response. Midgley 08:44, 28 April 2006 (UTC)

It is very important which antigen triggers the immune response. Kell(K1) HDN is mainly caused by blood transfusion reactions and it can occur very early in pregnancy and can be very severe. Surprisingly, little is done to screen for Kell antibodies for blood transfusions to young women. On the other hand RhE disease is mild (RhE disease does not have a page yet). The history of the discovery of RhD disease is fascinating. I feel that their are unique features to each antibody disease. At the monoment the articals are short, but in time each antibody could have quite a long artical with the unique feateure of each disease. I do see your point of view and perhaps a lot of the common data can go on the HDN page and the special unique points (and there are many) can go on separate artical pages. Perhaps I have overestimated this point, but I guess that separate antibody pages will encourge clear thinking (and avoid confusion for general readers) about the the separate antbodies and their quite different behaviour. Snowman 09:11, 28 April 2006 (UTC)

I don't agree that merge and redirect is in order either. Leave it alone. DonSiano 13:30, 28 April 2006 (UTC)

Do not merge. Leave it alone. Snowman 09:47, 29 April 2006 (UTC)

Transfusion antibodies: Hardly any young women have had a blood transfusion - screening may not be appropriate. Locally, however, the "group and save and unusual antibody" set which is done on each pregnant woman around 15 weeks of pregnancy I think would pick it up. I'm a general practitioner - IE I deal with people who might have one of these in more weeks than I don't, and the level of detail suggested by a comprehensive page - an article written as for a separate condition - for each of these seems both excessive for my requirements (which are likely to be met by something like http://ganfyd.org where I think we will be approaching it through articles on transfusion medicine and so on), and actually oppose my need to classify such things in terms of all the similarities, and then the specific differences. A Haematologist or PhD researcher might go looking for specifics on a single minor blood group inducing HDN (or nowadays, we'd hope to be dealing with haemolytic disease of the foetus) but WP probably isn't where he should go. The reader, who is interested in why the tests are done, or is looking at it for general knowledge, will be well-served by a core article and subsidiary ones giving some detail, I think. So not merge and redirect, but rather a brief passage and direction to the core article. (written by unknown editor)

The group and save done as part of antenatal care in UK does not include a Kell blood group type (ie RBC antigen type). If Kell immune antibodies (ie IgG antibody in the serum) are detected in this blood test then it may be too late for the pregnancy and intrauterine transfusion (or other treatment) may be indicated to save the baby. The aim is to prevent alloimmunization and not just to detect it. Kell blood typing for transfusion has been considered but it is not done because of the a great deal of work will need to be done to prevent only a few cases of Kell HDN. However this may change, as Rh disease is being prevented with anti-D antibody injections, other antigen HDN diseases (including anti-kell which can be very severfe) become relatively more prominent.Snowman 19:32, 28 April 2006 (UTC)

I understand that the declaired aim in the wiki is to provide free information for the general reader as well detail for specialist readers (see Wikipedia:WikiProject Clinical medicine#The audience), so I feel that detailed HND pages are entirely appropriate. Snowman 19:32, 28 April 2006 (UTC)