THE treatment of hemolytic anemia of the newborn often requires support by compatible blood transfusions. In the years before the discovery of the Rh factor, such blood was usually compatible only according to the A-B-O group, and for convenience the patient's father was often used as a donor. This meant the use of Rh-positive blood. It was found frequently at this time that the infants' blood levels tended to fall rapidly even with repeated transfusions. In many such cases the infused Rh-positive cells are destroyed much more rapidly than are Rh-negative cells as shown by Mollison in England and confirmed by us. It seemed best, therefore, as a first step in improving treatment, to use only Rh-negative blood as a means of achieving the highest blood levels for protection of the patient, and this step was logically inaugurated after 1941.In the more acute and severe cases of erythroblastosis the infant's anemia often progressed so rapidly in the first 48 hours that several small transfusions proved inadequate. In such patients, by recently developed technics, it has been possible to demonstrate that the serum of the baby still contains free maternal anti-Rh agglutinins and that all of the infant's own red blood cells are often completely coated with this antibody leading probably to a more rapid destruction of the infant's cells. The removal of as much as possible of the baby's own blood should theoretically help diminish the damage resulting from the presence of this free and bound antibody in the circulation and in the tissues. Such reasoning led to the trial of replacement transfusion for the treatment of erythroblastosis. Replacement transfusion is not a new procedure in pediatric practice as many of you know, but to perform it in a newborn infant has added difficulty to an inherently difficult technic.The earlier method consisted of entering the longitudinal sinus and a peripheral vein, or two peripheral veins, or a vein and an artery. These usually required more or less body exposure for a newborn infant on an operating table, often requiring an hour or more for the procedure and this sometimes caused shock-like symptoms from cold and trauma.
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