Hematology: A Rare Type of Blood

While crossing a Philadelphia street a year ago, Amelia Hutson, 24, mother of six, was hit by a car. She suffered a broken right leg and left thigh. At Temple University Hospital she got a one-pint transfusion of blood that seemed to match hers by all the usual tests, and she appeared to have no adverse reaction. One week later, though, the surgeons wanted more blood to use in an operation on Mrs. Hutson’s thigh. And then Dr. Lyndall Molthan, head of Temple’s blood bank, made a surprising discovery: she could no longer match Mrs. Hutson’s blood, even with that of the original donor. In the intervening week something drastic had happened: the transfused cells had all died, though they should have lived for 60 to 120 days. Mrs. Hutson had become sensitized to something in normal blood. The orthopedists had to set her thigh by manipulation.

Zulu Type. While her patient was recovering, Dr. Molthan sent blood samples to research centers around the world. From London came a suggestion: Mrs. Hutson’s blood seemed to be of the Shabalala type, named for Mrs. Elizabeth Shabalala, 42, a handsome, strapping Zulu in whom the type was first detected in Johannesburg, by Dr. Maurice Shapiro, after she had had a succession of stillbirths and miscarriages. With that information on hand, Dr. Molthan and the obstetricians knew they had an extraordinary problem to cope with when Mrs. Hutson became pregnant again last spring. She might need blood during delivery, and her baby would almost certainly suffer from Rh incompatibility and would probably need blood. And in all the world only seven people, all women with some Negro ancestors, were known to have Shabalala-type blood. Of these, only two or three would match Mrs. Hutson’s in all respects.

Blood groups are vastly more complex than the familiar indications on blood donors’ wallet cards or G.I.s’ dog tags.* No fewer than 24 different grouping systems, with an almost infinite number of possible combinations, are recognized, and there are half a dozen or more variants in the Rh group alone. Mrs. Hutson suffered from two abnormalities: her system would make antibody to destroy blood cells carrying the common Rh factor known as “D,” which her husband has, and which her expected baby would have. Worse, she would also make antibody against factors “E” and “e.”

In the Bank. The Temple doctors decided that somehow they must have compatible blood on hand for the delivery. Dr. Molthan took a pint of Mrs. Hutson’s own blood and stored it. She cabled South Africa, and back by refrigerated air freight came a pint of Mrs. Shabalala’s blood. Said Mrs. Shabalala, a darkroom technician in Johannesburg: “The doctor had to talk to me for a long time before I agreed to give blood—it is a procedure entirely foreign to the normal African.” At Manhattan’s Mount Sinai Hospital, Dr. Richard Rosenfield alerted a Puerto Rican patient to stand by. In Ohio, a statewide search for a prostitute known in medical annals as Pat Murphy found her free on bail in Akron. She was tapped for a pint.

Last week the Temple doctors delivered Amelia Hutson of a 7-lb. 3¾-oz. baby girl by induced labor, one week before term. Blood from the umbilical cord and subsequent drops from the baby’s finger showed Dr. Molthan that the child was indeed suffering destruction of her own blood cells by her mother’s antibody, transmitted through the placenta.

But at first the incompatibility was not of critical severity, and there was a chance that the baby’s own liver could handle the problem. If not, Dr. Molthan was standing by with red cells separated from Shabalala blood and with fresh-frozen plasma, free of the dangerous antibody, to tide her over until the maternal antibody died out and the baby’s own blood-forming system took control.

If Mrs. Hutson makes a smooth recovery, the Shabalala blood that has been collected from two continents may not be needed. But the doctors are justifiably proud of the precautions they took for the wife of a Philadelphia short-order cook. Explained Dr. Russell Ramon de Alvarez, head of Temple obstetrics: “These are the lengths to which we go to safeguard a mother and her baby.”

*These show whether the bearer has blood of type A, B, AB, or O, and whether the blood is Rh-positive or Rh-negative, for a total of eight possible combinations.