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10 years ago  ::  Sep 23, 2008 - 3:03PM #1
Posts: 2,174
Why are Jehovahs Witnesses who are Rh negative allowed to be treated with Rhogam ?

And why would God condemn blood transfusions if a babys blood cells may enter the mother's blood stream at delivery? A blood transfusion can also occur during procedures, such as an amniocentesis.

God is perfect... and is all-knowing. He knew this transfusion can happen during delivery.
Christ says, "I am the way, the truth and the life. No one comes to the Father except through me." (John 14:6)
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10 years ago  ::  Sep 23, 2008 - 6:19PM #2
Posts: 155
I was just about to post a new thread about this controversial topic, when I stumbled accross your post!   Last I knew, rhogam was technically allowed but highly highly discouraged.  (you know how they like to do that!!)  This may have changed but I am not sure. 

The transfusion during birth is not the only time when blood passes from mother to child.  It happens during the pregnancy, passing through the placenta and also after birth, during breast feeding when the breast milk is almost entirely made up of white blood cells. 

hmmm ... food for thought? ;)

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10 years ago  ::  Sep 23, 2008 - 10:06PM #3
Posts: 1,230
[QUOTE=Mandeboo;779245]Why are Jehovahs Witnesses who are Rh negative allowed to be treated with Rhogam ?

And why would God condemn blood transfusions if a babys blood cells may enter the mother's blood stream at delivery? A blood transfusion can also occur during procedures, such as an amniocentesis.

God is perfect... and is all-knowing. He knew this transfusion can happen during delivery.[/QUOTE]

I have not read much on this topic. However, this is what I have found to date:

The Rh Factor and You

THE proud father looks down happily at his newborn baby sleeping quietly in its mother’s arms. It was a long night in the delivery room, but now all of that is in the past. In comes the doctor to check on his patients and to congratulate all. “There’s just one thing, routine really,” he says.

The mother’s blood is Rh-negative, and a check showed that the baby’s is Rh-positive, so the mother will need to be given an immunizing shot. “It’s just a small injection made up of human antibodies but quite important,” the doctor assures them, “for preventing complications with future pregnancies.”

Though the doctor may consider the shot routine, the mention of it and possible “complications” brings up a set of questions in the minds of the concerned parents. What does this shot actually do? How necessary is it? What would happen if the parents did not want it? For the Christian another question emerges. Since the Bible says, ‘Keep abstaining from blood,’ can the Christian accept the shot in good conscience if it contains human antibodies from someone else’s blood?—Acts 15:20, 29.

History of the Rh Problem

Decades ago scientists discovered that human blood contains many factors, or antigens, that make each person’s blood unique. In time they learned that two antigen systems in the red blood cells caused most of the medical problems if one person’s blood was put in contact with another person’s. One of these antigens is termed “ABO”; the other is termed “Rh.” A brief review of the Rh system will help us answer the important questions these concerned parents have and that you too may have wondered about.

In 1939, doctors published the puzzling case of a 25-year-old woman whose second baby died during pregnancy. Following the delivery of the dead baby, the woman was given blood transfusions and developed severe reactions even though the blood was from her husband and apparently compatible with her own as respects ABO antigens. Doctors later surmised that some unknown factor from the blood of her first baby had mixed with her blood and had “sensitized” her blood, leading both to her reaction to her husband’s blood and to the loss of her second baby.

This unknown factor was later identified through experiments involving rhesus monkeys, so it was termed “Rh factor.” This blood factor was the subject of intense medical interest through the 1960’s because it was discovered to be the cause of a somewhat common and often tragic illness of babies called erythroblastosis fetalis. As doctors studied the Rh factor and the disease, a fascinating medical story unfolded.

Rh, Genetics, and Sick Babies

Most people are touched when a newborn baby is seriously ill or dies. Merely seeing an infant sick or in distress is hard on many, and doctors are no different. Two other reasons made this baby-killing Rh factor of especial concern to physicians.

The first was that doctors began to see a pattern with the disease and to understand how the Rh factor was involved in sickness and death. Rh factor is present in the red blood cells of about 85 to 95 percent of people, both men and women. They are termed “Rh-positive.” The 5 to 15 percent without it are labeled “Rh-negative.” If an Rh-negative person is exposed to the blood of an Rh-positive person, he or she may form molecules called antibodies that destroy Rh-positive blood.

This is really a common, normal response of the body’s immune system as it fights off foreign invaders. The problem is, an Rh-negative mother may have a baby who inherits Rh-positive blood from its father. This presents no problem when the placenta works perfectly and the baby’s blood is kept separate from the mother’s. (Compare Psalm 139:13.) But because our bodies are imperfect, a small amount of the baby’s blood may sometimes leak through and come into contact with the mother’s. Occasionally, this happens because of some medical procedure, such as an amniocentesis (drawing a sample of the fluid in the birth sac surrounding the developing baby). Or some of the baby’s blood may intermingle with the mother’s during delivery. Whatever the cause, the mother may become sensitized and make antibodies against the Rh-positive blood.

Picture the problem: Once the mother develops such antibodies, all succeeding babies are at risk if they should inherit Rh-positive blood from the father. This is because the mother now has antibodies to Rh-positive blood.

You see, certain antibodies pass the placenta normally. This is a good thing, causing all babies to be born with a degree of temporary natural immunity by way of their mothers. With Rh disease, however, the sensitized mother’s Rh antibodies pass the placenta and attack the Rh-positive baby’s blood. This rarely affects the first baby, being more common with any succeeding babies. It causes sickness, called Rh hemolytic disease of the newborn (erythroblastosis fetalis if the damage is severe).

There are many ways to manage this disease, though often with limited success, as we will see. Let us now focus on one medical aspect of the problem—a possible means of prevention.

A Breakthrough in Prevention

You may recall that there were two reasons this disease became so exciting to doctors. The first was that the mechanism of illness became known and understandable. What was the second reason?

It showed up in 1968. After years of research and frustrating attempts by doctors to treat these very sick babies, which met with limited success, an immunization was developed that was effective in preventing the problem of “Rh babies.” This was good news. But how did it work?

Recall that the Rh problem (for the second and succeeding Rh-positive babies) developed when blood from the first Rh-positive baby “leaked” into the Rh-negative mother’s bloodstream and caused her to produce antibodies. Could there be a way to snatch up the baby’s red blood cells in the mother’s system before they had a chance to sensitize her?

The method devised was an immunizing shot for the mother called Rh immune globulin, or RhIG, known in some countries by brand names, such as RhoGAM and Rhesonativ. It is composed of antibodies against the Rh-positive antigen. Exactly how it works is complex, and even unclear, but it basically seems to work the following way.

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YOU are my friends if YOU do what I am commanding YOU. (John 15:14)
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10 years ago  ::  Sep 23, 2008 - 10:06PM #4
Posts: 1,230
When an Rh-negative mother is suspected of having been exposed to Rh-positive blood, such as after the delivery of an Rh-positive baby, the mother is given an RhIG shot. These antibodies quickly attack any leaked Rh-positive red blood cells from the baby and destroy them before they sensitize the mother. This effectively eliminates the danger to the next baby, since no antibodies against Rh-positive blood are produced by the mother. The real advantage that doctors see in this is that it serves to prevent disease rather than treat it after it develops.

This sounds good in theory, yet has it worked? Apparently, yes. In one country, the United States, the incidence of Rh hemolytic disease dropped 65 percent during the 1970’s. Though many things could have contributed to this, 60 to 70 percent of this drop was attributable to the use of RhIG. In one Canadian province, the number of babies dying from Rh hemolytic disease decreased from 29 in 1964 to 1 between 1974 and 1975. The medical community saw this as verification of the principle that “an ounce of prevention is worth a pound of cure.” With this basic background, we can consider some specific questions that often arise concerning Rh disease.

What are the risks of having a problem with Rh disease during my pregnancy?

A simple blood test can determine the Rh blood types of mother and father; roughly 1 in 7 marriages is of an Rh-negative woman to an Rh-positive man. Aspects of the father’s genetic makeup bring the overall risk down to about 10 percent.

Those are overall population statistics, however. If you are an Rh-negative woman married to an Rh-positive man, your chances are either 50 percent or 100 percent of having an Rh-positive baby, depending on the genetic makeup of your husband. (There is no sure way to determine the genetics of the husband, just as there is yet no simple way to determine whether a baby in the womb is Rh-positive.)

For the Rh-negative mother carrying an Rh-positive baby, there is a 16-percent chance with each pregnancy that she will be sensitized, thus putting future pregnancies at risk. Of course, that is merely an average. Barring prior blood transfusion or other exposure of the mother to blood, the first baby of a marriage is usually free from the risk of Rh disease. After that first baby, the risk is actually somewhat difficult to predict in any given case. One woman may be sensitized with her very first Rh-positive baby. Another may have five or more Rh-positive babies and never be sensitized. If a mother becomes sensitized, the risk of death to each succeeding Rh-positive fetus is 30 percent, and this is not altered by the interval between pregnancies. So this is not to be taken lightly.

Can laboratory testing tell me if my developing baby is at risk?

Yes, to an extent. Antibody levels in the mother’s blood can be measured during pregnancy to tell if she is producing antibodies against the baby’s blood. Also, amniocentesis can help tell if the baby’s blood is being destroyed and the baby is in danger. Yet, amniocentesis sometimes presents its own complications, and so there ought to be caution about undergoing it.

Does the RhIG shot have side effects?

There is still some controversy about its use during pregnancy because of possible immunologic damage to the developing embryo. Yet, most experts conclude that the immunization is relatively safe both for the mother and for the developing baby inside her.

According to doctors, how often should I take the shot?

Authorities say that the shot should be given soon after any event that may have caused Rh-positive blood to enter the bloodstream of an Rh-negative woman. Thus, current recommendations are that the shot be given within 72 hours of delivery of the baby if the baby’s blood is found to be Rh-positive. The same recommendation holds for an amniocentesis or a miscarriage.

Furthermore, since studies have shown that a small amount of the baby’s blood may enter the mother’s bloodstream during normal pregnancy, some doctors recommend that the shot be given at 28 weeks into the pregnancy to prevent sensitization. In that case the shot would still be recommended again after the baby is born.

Is there any treatment for a baby once it gets Rh disease?

Yes. Though hemolytic disease of the newborn is a serious illness, there is good evidence supporting treatments that do not involve exchange blood transfusions for the baby. The most feared complication of this disease involves the buildup of a chemical called bilirubin, which results from the breakdown of red blood cells. This produces jaundice and can in some instances cause damage to the baby’s organs. (Incidentally, a mild jaundice may be caused when there is an ABO incompatibility between the mother’s blood and the baby’s blood, but this is usually not as serious.)

For some years doctors thought that a specific level of jaundice was indication for exchange blood transfusion in these babies, but further research has revealed various alternative treatments. Early delivery or cesarean section, phototherapy (blue light), and medications such as phenobarbital, activated charcoal, and other treatments have proved helpful and have dramatically decreased the push to resort to transfusion. In fact, some recent reports have highlighted the futility and even the danger of exchange transfusions in babies with Rh disease.—See box, page 26.

Nevertheless, there are extreme cases when doctors still insist that exchange transfusion is the only acceptable treatment. Therefore, some parents feel that it is better to avoid the whole problem with a shot that will prevent the disease and thus the jaundice.

Is the RhIG shot made from blood?

Yes. The antibodies that make up the shot are harvested from the blood of individuals who have become immunized or sensitized to the Rh factor. Genetically-engineered RhIG not derived from blood may become available in the future.

Can the Christian conscientiously take RhIG?

The issue involved is the possible misuse of blood. The Scriptures quite emphatically prohibit the eating or other misuse of blood. (Leviticus 17:11, 12; Acts 15:28, 29) Since RhIG is produced from blood, would it be in violation of the Bible command to abstain from blood if a Christian woman were to accept the shot?

This journal and its companion, The Watchtower, have commented consistently on the matter. We have noted that in all pregnancies antibodies freely pass the placenta between mother and baby. Hence some Christians have concluded that to them it does not seem a violation of Bible law to take a shot consisting of antibodies, like RhIG, since the process is essentially like what happens naturally.

The decision whether to take RhIG remains finally, though, a matter for each Christian couple to decide conscientiously. However, if a husband and wife facing the Rh issue decide not to take the RhIG when medically indicated, they need to be willing to accept the risk of having a future child seriously affected by an illness that could possibly have been prevented. In this situation they might even decide that the course of wisdom is to take extra precautions so they do not have more children and expose themselves to the possibility of such a tragedy. Concerned Christian parents should prayerfully consider all aspects before making such weighty decisions.
Who was Jesus?
Who is Jesus?
YOU are my friends if YOU do what I am commanding YOU. (John 15:14)
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