BASIC MEDICAL EDUCATION FOR

MARRIAGE
DR. T. O ADELEKE(MBBB,FWACP,(FM)
BOWEN UNIVERSITY HOSPITAL
Objectives
⚫Understanding marriage
⚫Understanding the differences in blood group and
rhesus Factor
⚫Challengesof blood group and rhesus incompatibility
⚫Genotype and the risk of incompatibility
⚫Premarital medical screening
⚫Pre-conceptional Care
The love story of the ages:

Man and woman meet,

they fall in love,
they marry, and
they live happily ever after.
THE BIBLICAL STORY…

Genesis 2: 18, 21-24CEV

Gen 1:27,28
Gn 2:18, 21-24 CEV
The Lord God said, “It isn't good for the man to live
alone. I will make a suitable partner for him.” So
the Lord God made him fall into a deep sleep, and
he took out one of the man's ribs. Then after closing
the man's side, the Lord made a woman out of the
rib. The Lord God brought her to the man, and the
man exclaimed, “Here is someone like me! She is
part of my body, my own flesh and bones. She
came from me, a man. So I will name her
Woman!” That's why a man will leave his own
father and mother. He marries a woman, and the
two of them become like one person.
Gen 1:27,28 TCV

“So God created humans to be

like himself; he made men and
women. God gave them his
blessing and said: Have a lot of
children! Fill the earth with
people and bring it under your
control…”
Let’s talk…
➢ Who established marriage as
an institution?
➢ What are the roles of the union
between a man and a woman?
➢ What are the areas where
compatibility or suitability is
important in marriage?
THE BIBLICAL PERSPECTIVE
Marriage purpose
⚫For companionship. God noticed how lonely
Adam was and made Eve for him. “The Lord God
said, It isn’t good for the man to live alone. I will
make a suitable partner for him.”Gen 2:18TCV
⚫For procreation. “So God created humans to be
like himself; he made men and women. God gave
them his blessing and said: Have a lot of children!
Fill the earth with people and bring it under your
control…” Gen 1:27,28 TCV
Culturally speaking…
⚫Almost every tribe and tongue in Nigeria and
other sub-saharan countries (Africans) play
emphasis on procreation abovecompanionship as the
essence of marriage
⚫The same is applicable in the Jewish culture…our
mothers of faith (matriarch)-Sarah, Hannah,
Elizabeth sought God earnestly to bare children
Compatibility in Marriage
(Biblical Perspective)
AREAS OF AGREEMENT SHOULD INVOLVE:
❖ PHYSICAL
❖ SPIRITUAL
❖ MEDICAL ( EMPHASIS OF THIS LECTURE)
❖ CAREER E.T.C
 MEDICAL
AGREEMENT
Challenges faced pre-medical
advancement
⚫ Recurrent pregnancy losses
⚫ Neonatal, Infant and Under 5 mortality and morbidity

Before the genetic medicine became popular

and prominent, the rate of mortality among
children was really high because people do not
possess any knowledge about genotypes and
blood groups.
Pre-medical advancement (Contd)
⚫The people’s ignorance was what causes them to
consider children’s death to be curses or bad luck
• Yorubas used to refer to such children as “abiku”

⚫Could this be due to incompatibility in marriage ?

⚫Blood Group Compatibility
Blood Group System
⚫Two major types of blood group system:

⚫ABOBlood Group System:TheABO system is the

most important blood-group system
in human-blood transfusion.
⚫Rhesus (Rh) BloodGroup System:The Rh system is
the second most significant blood-group
system in human-blood transfusion and
childbirth.
ABO Blood Group
Everybody has a blood type.There are four major blood
groups:

⚫A
⚫B
⚫O
⚫ AB

These groups differ primarily on the presence or absence

of antigens that can stimulate an immune response.
Rhesus (Rh) Blood Group
⚫ Atype of protein found on red blood cells is called rhesus
factor. Rh factor is inherited (passed from parents to children
through the genes). So, based on this rhesus factor, there are
two blood group.
⚫ If you have Rh factor, you're
⚫ If you don't have it, you're

Most people are

ABO + Rh factor
⚫ THE USE OF THE TWO BLOOD GROUP SYSTEM FURTHER DEFINES
BLOOD GROUPS INTO EIGHT COMMON TYPES:

⚫ A+
⚫ A-
⚫ B+
⚫ B-
⚫ O+
⚫ O-
⚫ AB+
⚫ AB-

⚫ YOUR BLOOD TYPE IS SOMETHING YOU INHERIT, SO IT’S

PREDETERMINED AT BIRTH. IT DOES NOT CHANGE.
Blood compatibility
⚫Whether you haveRh factor or not doesn't affect
your general health. However, it can cause
problems during pregnancy, where both partners
are the biological parents. That’s because of Rh
factor.

⚫Rh Incompatibility is a condition that occurs

during pregnancy if a woman has Rh-negative
blood and her baby has Rh-positive blood.
Rh factor and pregnancy
⚫Rh factor can be a concern if the
biological mother is Rh- and the baby is
Rh+.

⚫Although mother’s and baby’s blood typically do

not mix during pregnancy, a minimal amount of
baby’s and mother’s blood could come in contact
with each other during delivery.
Rh factor and pregnancy (contd)
⚫If there’s an Rh incompatibility and this happens,
mother’s body might produce Rh antibodies
against Rh factor.
⚫These antibodies will not cause problems to an
Rh+ baby during the first pregnancy. But they
can cause issues if you haveasubsequent
pregnancy and are carrying another child that is
Rh+ . This can lead to habitual (recurrent)
abortion or neonatal mortality.
Illustration of Rh sensitisation
Table of Rhesus compatibility match
Father Mother Compactibility

Rh - Positive Rh - Positive Compatible

Rh - Negative Rh - Negative Compatible

Rh - Positive Rh - Negative Incompatible

Rh - Negative Rh - Positive Compatible

Blood transfusions between partners
⚫ Compatible blood types could be useful if you or your
partner need ablood transfusion. People without
compatible blood types cannot donate blood to each
other.Atransfusion of the wrong type of blood product
can result in a potentially fatal toxic reaction.

⚫ Being able to supply needed blood for a partner with a

medical issue might not be a deal breaker for most
couples, but it could be a nice perk in the event of an
emergency.
Blood transfusion and partner
⚫ If you have type AB+ blood, you are a universal
recipient and can receive red blood cells from all donors.
⚫ If you have type O- blood, you are a universal donor and
can donate red blood cells to anyone.
⚫ If you have type A blood, you can receive type A or type O
red blood
cells.
⚫ If you have type B blood, you can receive type B or type O
red blood cells.
⚫ Rh+ or Rh- blood can be given to those who are Rh+, but if
you are
Rh-, you can only receive Rh- blood.
GENOTYPE
Genotype
⚫Genotype simply refers to hemoglobin gene
constituents. Genes are always in pairs.
⚫So there is no problem when one of the genes is
abnormal.This is called a CARRIER STATE.
⚫A is a normal gene, S and C are abnormal.
⚫When the two are abnormal then there is a great
problem.
⚫The genotypes in humans are AA, AS, AC, SS,
SC
Genotype (contd)
⚫The great problem to avoid with genotype
matchmaking for intending couples is the sickle
cell disease- a very serious medical condition that
significantly reduces lifespan and makes a person
to struggle physically in-and –out of hospital.
Pains of genotype incompatibility:
Could be male or female
Pains of Genotype Incompatibility
Genotype compatibility
GENOTYPE COMMENT

AA AND AA EXCELLENT

AA AND AS/AC GOOD

AS/AC AND AS/AC BAD

AS/AC AND SS REALLY BAD

SS AND SS THE WORST

 Genotype Compatibility Match
Genotype Compatibility Rating (Chances out of Remark
four offspring)
AA x AA All offspring will be Normal Excellent.They can marry

AA x AS 2 will be normal; 2 will be carrier Good.They can marry

AA x SS All offspring will be carrier Fair.They can marry

AA x AC 3 will be normal; 1 will be carrier Good.They can marry

AS x AS 1 will be normal; 2 will be carrier; 1 will have Fair but not recommended
SCD

AS x SS 2 will be carrier; 2 will have SCD Not recommended

or AC x
SS
AS x AC 1 will be normal; 2 will be carrier; 1 will have Fair but not recommended
or AC x SCD
AC
SS x SS All offspring will have SCD Not recommended
Take note…
⚫AA- Normal
⚫AS &AC- Sickle cell trait/Carrier
⚫SS- Sickle cell disease/SCD

⚫NB:
⚫1) In the compatibility illustration earlier
described, the compatibility rating is agame of
chance. The 5th 6th and 7th scenarios are not that
straight forward.
Take note (contd)
⚫2) Of course there are many cases where two
abnormal was combined that is anASandASor
AC andAC orAC andAS couples and had up to
five or six children without a single sicklier
among them. But why risk it?What if you're not
so lucky? Can you forgive yourself when you end
up having a child with the sickle cell disease and
put the child through the agony the disease brings
when you could have easily avoided it?
Take note (Contd)
⚫3) Compatible genotypes for marriage are:AA
marries anAA. That's the best compatible. That
way you save your future children the worry
about genotype compatibility.
⚫4)AAmarries anAS.You'll end up with kids with
AAandAS which is good. But sometimes if
you're not lucky all the kids will beAS. Like I've
said there's no problem having kids withAS
except if eventually the kids marry people with
the genotypeAS.
Recently in the Nigeria news….
⚫ Bill making blood tests compulsory for intending couples scales
second reading.
https://www.premiumtimesng.com/news/top-news/392488-bill-
making-blood-tests-compulsory-for-intending-couples-scales-
second-reading.html
(PremiumTimes News ofWednesday, 13th May, 2020)

The bill is meant to prevent, control and manage the occurrence,

spread &effect of Sickle CellAnaemia (SCA)
One of the provisions of the bill seeks to prevent persons who are
carriers (AS,AC and SS) of the diseased gene from marrying other
carriers)
The bill is sponsored by Dr Sam Egwu
The takeaway (1)
⚫Intending couples must make sure to know their
genotypes and be sure it's compatible for
marriage before going ahead to get married.

⚫But as for ASmarrying an ASall in the name of

“Love”, is a deliberate act of destruction to the
future generation.
The takeaway (2)
⚫Blood group compatibility for marriage is limited
to possible Rh factor incompatibility during
pregnancy.And that is further limited to
pregnancy where both partners are the biological
parents.
⚫There are also couples who value blood group
compatibility for the potential of providing blood
transfusions to their partner.
The takeaway (3)
⚫Rhesus factor does not constitute an absolute
contraindication why a Rh -ve woman should
not marry a Rh + ve man.There is a drug that can
be used to prevent sensitization if the Rhesus
status of the couple is known initially.
Conclusion
⚫Before saying “I do”know your blood group and
genotype.

⚫Help in preventing genetic diseases by marrying a

partner of compatible genotype. Let’s save our future
generation byeradicating this abnormality in our
society.

⚫Determine the Rhesus status of every newly-born

child.
References
⚫Does BloodTypeAffect Marriage Compatibility?
Medically reviewed by Elaine K. Luo, MD on
June 28, 2019 —Written by Scott Frothingham

⚫Okoduwa 2013. Blood group and genotype

compatibility. InfohealthAwarenessArticle.Vol 1,
No.2: PP 84-87
THANK YOU
AND
ANY
QUESTIONS?