451

FŒTAL ERYTHROCYTES
IN THE MATERNAL CIRCULATION
ALVIN ZIPURSKY
M.D. Manitoba

In-vitro mixtures of foetal and adult blood were made

and smears prepared as described above (fig. 1). Arbitrarily, each smear was scanned for 2 minutes under low
power. The numbers of fcetal cells seen in a 2-minute
scan of smears of various dilutions were:

RESEARCH FELLOW IN DEPARTMENT OF PÆDIATRICS

ALAN HULL
RESEARCH

B.Sc. Manitoba
ASSISTANT, DEPARTMENT

OF BIOCHEMISTRY

F. D. WHITE
Ph.D. Edin., F.R.I.C.

et al. (1957) recently reported that the

of
haemoglobin adult red cells in a fixed smear was readily
eluted by an acid phosphate buffer whereas the hæmoglobin of foetal cells was not. We have applied this
observation to the detection of small numbers of foetal
cells in the blood of newly delivered women.

When three adults were given 3, 5, and 15 ml. of compatible placental blood intravenously, the foetal cells were
demonstrated in the expected concentration in their blood
(figs. 2 and 3). In the adult receiving 15 ml., the foetal cells
were still demonstrable 6 weeks after infusion.
The blood of 90 blood-donors (males and nonpregnant females) was examined. No foetal cells were
found.
The blood of 42 mothers, selected at random without
reference to the blood-groups of mother and child, was
examined on the 2nd to 6th day post partum with the
following results:

Venous blood was collected with ammonium-potassium

oxalate as anti-coagulant, and diluted 1 in 3 with normal saline.
Smears were made of this saline suspension, dried, and fixed in
absolute ethyl alcohol for 2 minutes. After fixation and drying,
the slides were washed for 90 seconds in citrate phosphate
buffer (0-16M K2HPO4 and 018M citric acid, pH 3-4-3-6 at
37 C). They were stained with May-Gruenwald and then
washed until practically no stain was visible to the naked eye.
After drying, they were examined microscopically under low
power. Foetal cells appeared as pink-staining refractile cells in
a field of erythrocyte ghosts (figs. 1-4).

A foetal erythrocyte in a maternal smear is shown in fig. 4.

The finding that 11 out of 42 (21 %) postpartum women
had foetal cells in their circulation suggests that trans-

PROFESSOR OF BIOCHEMISTRY

L. G. ISRAELS
M.D., M.Sc. Manitoba, F.R.C.P.(C.)
ASSISTANT PROFESSOR OF BIOCHEMISTRY

From the

Faculty of Medicine, University of Manitoba,

Winnipeg, Canada

Kleihauer

Fig. 1—In-vitro mixture of faetal and adult red cells. The fœtal cell
appears as a relatively intact refractile cell in a field of adult
,hosterythrocytes.
"

Fig. 3—High-power

view of the

same.

Fig. 2-Low-power photomicrograph of a feetal cell in

3 weeks after injection of 15 mL placental blood.

Fig. 4-Fœtal cell in

postpartum mother.

an

adult,

452
tube (10 cm long)
bent at right-

placental passage of foetal blood is rather common. This

finding, obtained by a relatively simple technique, is in
agreement with those suggested by the more complex
methods of Creger and Steele (1957) and of Hosoi (1958).
This method has the advantage of not being dependent
on the blood-groups of the mother or foetus.

angles so

This study was aided bp grants from the Playtex Parlt Research
Foundation and the National Cancer Institute of Canada. We wish
to express our thanks to Dr. B. Chown and Dr. J. Hoogstraten for

This studywasaided bygrantsfrom thePlaytex Park Research

help

and advice.
REFERENCES

Creger, W. P., Steele, M. R. (1957) New Engl. J. Med. 256, 158.

Hosoi, T. (1958) Yokohama med. Bull. 9, 61.
Kleihauer, E., Hildegard, B., Betke, K. (1957) Klin. Wschr. 35, 637.

A SIMPLE PORTABLE AID TO RESPIRATION

JAMES MACRAE

R. V. WALLEY

M.D. Glasg., F.R.F.P.S., D.P.H.

M.D. Cantab.

PHYSICIAN

DEPUTY PHYSICIAN

ing acts as a
mouthpiece and is
readily replaceable.
.

H. K. LUCAS
M.B.E., M.Ch. Orth. Lpool, F.R.C.S.E.
ORTHOPÆDIC SURGEON

HAM GREEN

HOSPITAL, PILL,

NR. BRISTOL

WHEN
patients vital capacity is permanently small,
his horizon is limited largely by the mass of mechanical
equipment needed for artificial respiration.
So-called portable apparatus, such as the Monaghan
cuirass respirator, is not easily manageable, and with
batteries, it weighs as much as 150 lb. Glossopharyngeal
breathing (Dail et al. 1955), if the patient can achieve it, is
the ideal aid to respiration; but we have had many
disappointments with it. Hence we have tried to devise
simple equipment for artificial ventilation which would be
truly portable as well as reliable.
A blower mechanism suggested itself-such as would
have a high delivery of air and develop a pressure of about
15 cm. of water.
a

After

as to con-

form to the angle

of the patients
chin. The other
end of this metal
tube has a short
(6 cm.) length of
plastic tube connected to it. This
small piece of tub-

with various types of small blower we

are
met by the Hoover
.
This instrument is small,
Dustette vacuum-cleaner.
(length 28 cm., height 11 cm., weight 2.45 kg.), and can be
obtained commercially to work off a 12-volt battery. Since the
dustette is used in reverse, as a blower, the collecting-bag
assembly is removed and replaced by an airtight tubed
aluminium alloy plate machined to fit the blower end of the
machine. Plastic tubing (½ in. internal diameter) of suitable
length (about 1 metre) is attached to the metal tube of the
plate. The other end of the plastic tube is connected to a metal

experimenting

found that these requirements

The mouthpiece is held by

the patients
teeth, the blower
is switched on,
and inspiration
can occur to

any

required depth
simply by holding the mouthpiece loosely

Fig. 2-Respirator in use

3. Metal angle-piece,
4. Flex to battery.

1. Dustette.
2. Breathing-tube.

between the teeth and closing the mouth and nasopharynx.

Biting the mouthpiece firmly permits expiration. These
simple breathing movements have been mastered almost
immediately by five of our patients who have vital
capacities of about 300 c.cm. A humidifier does not seem
to be necessary. The patients can readily control inspiration and vary its volume at will. " Vital capacities " of
1500 c.cm. are easily achieved. Comfortable artificial
respiration by this method can go on for long periods, or,
as is more usual with our patients, intermittent short
intervals of " blower breathing " can be used to relieve
the effort of breathing at low levels of vital capacity. With
the blower equipment, talking is possible and expansion
of the lungs is remarkably good. Our patients have come
to trust the reliability of the blower respirator. Its small
bulk allows long journeys in a wheel chair, and motor-car
rides have for the first time become possible for these
patients. Naturally, the improvement in their morale is
substantial. The tubing is not unsightly and gives an
impression of pipe smoking. The apparatus makes littk
noise and does not attract attention in public places
Patients cannot, of course, sleep or eat while using the
blower.
One patient with a vital capacity of about 250 c.cm. was
successfully taken 180 miles by ambulance and train using the
blower " intermittently on the train and wholly on both
ambulance journeys. Another similar patient was perfeaJ1
happy with blower respiration before, during, and after III
operation performed under local anaesthesia in an operating"

theatre

1.
2.
3.
4:

Fie. 1-Dustette blower respirator.

Dustene.
5. Angled metal tube.
6. Plastic tubing mouthpiece.
Aluminum plate.
7. Dustette switch on carrying handle.
Electric lead to battery.
8. Direction of air-flow.
Plastic tubing.

some

distance from his ward.

To drive the dustette we have used a 12 volt Nift

battery of 20 ampere-hours capacity. Fully charged, this
battery will operate the blower continuously for as15 long
cm.
as three hours at pressures of between 20 to
of water, and the blower does not heat up during sucb
a continuous run. The battery measures 44 22 19 cm.
and. weighs 18 kg. It is readily accommodated beneath
the seat of a wheel chair. The cost of the
very modest.

apparatus is

REFERENCE

Dail, C W., Affeldt, J. E., Collier, C. R. (1955) J. Amer. med. Ass.

158, 465.