The man with golden arm

Laleh Lohrasbi tells the story of how the cure for Rhesus disease was found

James Harrison is the Australian donor whose blood has saved millions of lives over the world including almost all of the Australian babies at risk of developing Rhesus disease. Rhesus disease is a condition in which antibodies in a pregnant woman’s blood destroy her baby’s blood cells. It’s also known as haemolytic disease of the foetus and newborn (HDFN).

One out of every 1000 babies is subjected to Rhesus disease, a form of severe anaemia that may occur in the second or subsequent pregnancies of Rh-negative women when the foetus’s father is Rh positive. The disease can be prevented with two simple intramuscular injections during the first pregnancy, but what is the injection and where does it come from?

Today blood groups are so well known that everybody knows what their blood type is and is aware of what blood types they can receive in a medical emergency. However, just less than one hundred years ago, it was not so.

The first blood transfusion was performed in 1900, but back then doctors wondered why some transfusions were successful while others were deadly. It took a quarter of a century for physicians to find out about blood groups and their subgroups. There are four principle blood groups known as A, B, AB and O. Blood groups are determined by proteins called antigens which can be found on the membrane of red blood cells. People who have an antigen on their red blood cells have blood group A, while people with B antigens, have blood group B. People who have both A and B antigens have blood group AB and those who do not have any of the above antigens have blood group O.

However, there are also some other kinds of antigens on the blood cells’ membrane of which the most important is Rh (D) antigen or factor. The existence or lack of this factor determines whether one is Rh positive or negative. All of the A, B, AB or O blood groups can be Rh positive or negative.

The importance of blood groups comes into light when blood transfusion is needed. Each blood group is compatible with its own antigens and if exposed to other antigens the body will start to make antibodies against them. For example, if someone with blood group A receives blood from group B, his or her body will produce antibodies against B antigens, which by attaching to the red blood cells will coagulate the red blood cells and cause death. The same thing can happen in the case of infusion of Rh-positive blood to someone who is Rh negative.

When a woman who is Rh-negative is having a baby whose father is Rh positive, there is a high probability that the infant will become Rh positive. Usually during birth, a little bit of the infant’s blood passes into the mother’s blood circulation. In this case, as the mother is Rh negative then her body will produce antibodies against Rh antigens present in the foetus’ blood. These antibodies will remain in the mother’s blood. While the first child will be unaffected, in the second or subsequent pregnancies, these antibodies will pass through the placenta into the foetus’ blood circulation and if the level is sufficiently high, it will cause the destruction of Rhesus D positive foetal red blood cells leading to the development of Rhesus disease. In 86% of the cases, blood mixing happens during birth, but in 14% of the cases, it happens before birth.

Fortunately, most Rh disease cases can be prevented by injecting the mother with Rho(D) immune globulin during pregnancy or soon afterwards. Rho(D) immune globulin is the antibody against Rh (D) antigens, its job is to deactivate foetus antigens right after they get into the mother’s blood, before the mother’s body has had a chance to produce any antibodies.

The injection of anti-Rh antibody is done at 28 weeks of pregnancy with a booster at week 34. The induced immunity by the injection of anti-Rh wears off after 4-6 weeks, this period is long enough to prevent the formation of antibodies by the mother’s body and is short enough not to get into the foetus’ blood circulation in the second or subsequent pregnancies.

The anti Rh antibody is derived from human plasma, from Rh negative people who have been exposed to Rh positive blood. This includes Rh negative women who have their first pregnancy with an Rh positive baby. These women are in fact the victims of Rhesus disease themselves and may have lost more than one baby in second and subsequent pregnancies. However, by donating their blood, they can save the lives of many other babies.

Between them, American Marilyn McCarthy, 72 and Elizabeth Pascoe, 68, may have saved tens of thousands of babies over the years. These ladies did not want other pregnant women to go through what they have experienced. So for 25 years and 30 years respectively, they have travelled at least twice a week from their homes in Buffalo to a nearby lab to donate plasma.

The story of James Harrison is however different. Doctors believe that he has an extremely rare kind of blood which contains the anti Rh antibodies. When Harrison was 14, he had a chest operation to remove one of his lungs. This procedure made him lose lots of blood, and doctors had to inject 13 units of blood into his body. That was the time, Harrison decided to give back. When he was 18 he began to donate his blood. He has done so almost every 3 weeks for 60 years now! Meanwhile doctors who were struggling to find a cure for Rhesus disease found out that Harrison’s blood contains the magical antibodies they needed. There are over 500,000 blood donors in Australia but only 50 of them have the anti Rh antibodies.

Harrison has donated blood over 1100 times. His name is in the Guinness Book of Records and he is known at home as ‘the man with the golden arm’. Every single batch of AntiD in Australia has had a little bit of James in it. Harrison has never thought of stopping. However, when he becomes 80, he will not be able to donate blood anymore, so it will be others’ turn to give back what they have been gifted.


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