Indentation Caused By RH Factor?

Published: September 01, 2013
Dear TeenHealthFX,

Ever since I can remember, I've had mysterious indentations on the tops of my feet. Two of them on each foot, in a pair right between my largest and second toe. As I've gotten older they've stretched a little bit, but they're still clearly visible. The indentations are perfectly circular and very small, and so shallow I have to get my feet at a very steep angle against a light source before they become visible. If you've ever clicked a ball-point pen shut and pressed the circular area against your hand until it left a mark, they look a lot like that. If they're scars, they aren't normal ones- no discoloration, numbness to touch, or other signs of scar tissue formation. They never itch or hurt and they aren't really bothering me, but no one knows what they are, including my parents. I was born with a rare blood disorder that my mom can't remember the name of (I think it might have been the Rh factor combined with another, less common blood protein issue) which required me to have some pretty serious transfusions in my first few days of life. This seems like the most likely source of my mysterious circular marks (needle marks?) but I haven't found any books, web sites, or other resources to corroborate my idea. Does this seem plausible and/or are there any other explanations? Please & thank you.

Dear Indentation Caused By RH Factor?,

TeenHealthFX wishes we could give you an precise answer but proposing a diagnosis for your case without doing a thorough history and physical exam is extremely hard and might be inaccurate.  If these indentations cause you discomfort and distress, we would highly recommend you to make an appointment with your physician. If you don't have a doctor and live in northern New Jersey, you can call the Adolescent/Young Adult Center for Health at 973-971-5199 for an appointment with an adolescent medicine specialist. You can also contact your insurance company for a list of in-network providers.

TeenHealthFX believes it is important to address the topic of Rh incompatibility that you mentioned in your question.  Rh incompatibility can occur if a woman with Rh (-) blood gives birth to a child with Rh (+) blood.  Rh (+) and Rh (-) refer to whether your blood has Rh protein on red blood cells or not.  Rh (+) refers to having this protein on your red blood cells while Rh (-) implies not having this protein.  Rh factor is inherited and most people are Rh (+).  When a woman is pregnant, blood from her baby can cross into her bloodstream at any point in pregnancy but especially during delivery. If a woman is Rh (-) and her baby is Rh (+), mother’s body will react to the baby's blood as a foreign substance.  Mother’s body will create antibodies (proteins) against the baby’s Rh+ red blood cell which ultimately results in breaking down of these cells leading to hemolytic anemia also known as hemolytic disease of newborn. Hemolytic anemia is a process where the speed of red blood cell breakdown exceeds red blood cell production.   Red blood cells function to carry oxygen to the body and thus the disease can be fatal for the affected child if not properly treated.  Once affected, these children require multiple blood transfusions.  It is important to note that the antibodies usually don't cause problems during the first pregnancy with an Rh(+) child. This is because the baby is often born before many of these antibodies develop. However, the antibodies and stay in the mother’s body once they have been formed. Thus, Rh incompatibility is more likely to cause problems in second or later pregnancies (if the baby is Rh (+) in any of those pregnancies).  The good news is that with proper prenatal care and screening, Rh incompatibility problems can be prevented.   Screening during pregnancy is performed as part of typical pre-natal care protocol for all pregnant women.  That is one of the many reasons why having pre-natal care is so important during pregnancy.  Women who are found to be at risk for this condition are given injections of Rh immune globulin (RhoGAM) which helps neutralize the antibodies against the Rh+ protein of the baby.  This strategy has proven to be highly effective in preventing hemolytic disease of the newborn.  








Signed: TeenHealthFX