The Rhesus Factor

GENOTYPING

First of all, the terms Rhesus positive and Rhesus negativeare now, more frequently, being described as Rh(D) positive and Rh(D) negative. This section should hopefully explain why the transition has become necessary and, also, provide basic information about the Rhesus factor. Although the initial thought of reading through this may seem daunting, you may prefer to come back to it if you encounter any information which needs reinforcing. Alternatively, for an adequate understanding that can be applied to the other sections, skip to the end of the detailed section and read the simplified explanation below.

Detailed Explanation:

We all inherit a set of three Rhesus (Rh) genes from each parent called a haplotype. You may have heard of the c, d, e, C, D and E genes. The upper case letters denote Rh positive genes and the lower case, negative and we inherit either a positive or negative of each gene from each parent (eg. CDe/cde, cdE/cDe etc.). This means that we then possess two of each gene and can pass either to ouroffspring.

If a person is tested Rh positive, their blood is said to contain the Rhesus factor - if they are tested negative it does not. A person possessing one or more positive Rh genes (C, D or E), anywhere in their inherited haplotypes, has inherited the Rh factor (eg. cdE/De, cde/cDe etc.) and they are tested Rh positive - only a person with a genotype of cde/cde is truly Rh negative.

In this respect, it is now common practice to refer only to the D gene when determining the Rh factor of a person`s blood. The term now used is `Rh(D)` instead of just `Rhesus`. This ensures that we concentrate solely on the D gene, or lack of it, as Rh(D) positive cells contain a substance (D antigen) capable of stimulating Rh(D)negative blood into producing harmful antibodies. These antibodies destroy (hemolyze) red cells containing the D antigen (Rh(D) positive cells). The c, e, C and E genes are of little importance here, as cases where antibodies have been produced against them are very rare, although there have been instances where this has occurred and treatment has become necessary. Information about them is still found in pregnancy booklets.

This may help to explain why the harmful antibody produced by a Rh(D)negative woman`s immune systemagainst Rh(D) positive cells is called `anti-D` (anti-Rh(D) - also the name of the injection given to a woman at delivery - see `The Purpose of Anti-Rh(D) Injections`). This injection is sometimes also referred to as RhoGAM or Anti-D Immunoglobulin.

PLEASE NOTE: A Rh(D) positive woman would never produce an antibody against a Rh(D) negative child, as positive blood does not produce `anti-d` - there is no anti-Rh(d).

A person is Rh(D) negative if they have inherited a d gene from each parent (d/d).

A person is Rh(D) positive if they have inherited either of the following: 

- a D gene from each parent (D/D)

- a D from one parent and a d from the other (D/d or d/D)

Therefore, it is possible to have a Rh(D) negative child if the mother is Rh(D) negative and the father Rh(D) positive. The father may have inherited both a D and d and it is possible that the baby could inherit the negatived gene from him. As Rh(D) negative woman definitely possess two d genes, the baby would inherit one of these from her - this combination would produce a negative child (d/d).

If the father possesses two D genes, the baby will definitely inherit a positive from him, together with the Rh(D) negative gene (d) from the mother. This combination will produce a Rh(D) positive child.

PLEASE NOTE: If a Rh(D) negative woman is absolutely certain that her partner is also Rh(D) negative, they will surely produce Rh(D) negative offspring and the baby will not be affected by Rh(D) problems, even if the mother already carries Rh(D) antibodies from a previous pregnancyor miscarriage with another partner or as a result of a transfusion using positive blood cells.

Even though both the d and D gene are referred to here, the term Rh(D) does indicate that the d gene is not really the issue here - the test performed is to determine the presence or lack of the D gene:

If a blood test shows that you do not possess the D gene, you are described as Rh(D) negative.

If this gene is found to be present, you will be described as Rh(D) positive.

So, for example:

If your blood type is B Rhesus positive (B+), the more accurate way of describing this is B Rh(D) positive (D gene is present).

If your blood type is A Rhesus negative (A-), it would be described as A Rh(D) negative (D gene is not present).

So, we can now see that if you possess the D gene and are, therefore, Rh(D) positive, your blood will contain the D antigen which stimulates Rh(D) negative blood into producing antibodies (anti-Rh(D)) against it.

At the risk of complicating this subject even more - a man who has inherited both positive factors (D/D) would be described as being Homozygous - meaning that every one of his sperms must contain the D gene. If a he has both (D/d or d/D) he would be described as being Heterozygous - meaning that 50% of his sperms contain the D gene and 50% contain d.

Simple Explanation:

Whatever our blood type (ie. A, B AB, O), we all have two Rhesus genes, called D or d, depending on whether we are Rhesus positive or negative and babies inherit one of these from each parent.

A person is Rh(D) negative if they have inherited a d gene from each parent (d/d)

A person is Rh(D) positive if they have inherited either of the following:

- a D gene from each parent (D/D)

- a D from one parent and a d from the other (D/d or d/D)

This is why it is possible to have a Rh(D) negative child if the mother is Rh(D) negative and the father Rh(D) positive. If the father has both a negative and a positive gene, the baby may inherit this negative gene and, as all Rh(D) negative women have two negative genes, the baby will definitely inherit a negative from her.

PLEASE NOTE: If a negative woman is absolutely sure that her partner is Rh(D) negative, they will surely produce Rh(D) negative offspring and no harm can come to the baby from any Rhesus antibody the mother`s blood may contain, even if she had already developed Rhesus Iso-immune disease before the pregnancy.

Rh(D) positive blood contains the D antigen which stimulates Rh(D) negative blood into producing antibodies against it. Anti-Rh(D) is also the name of the injection given after delivery (more commonly known as `anti-D`).

PLEASE NOTE: A Rh(D) positive woman would never produce an antibody against a Rh(D) negative child, as positive blood does not produce `anti-d` - there is no anti-Rh(d).

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ANTIBODIES/ANTI-RH(D) AND THEIR EFFECTS

Antibodies against Rh(D) positive cells will be present in the mother`s bloodstream if she has previously had a Rh(D) positive baby and received no anti-D - in my experience most unlikely - midwives are just dying to stick a woman with an anti-D after delivery, appearing most disappointed when the baby is found to be negative and the mother is not in need of it! Antibodies will also be present if the mother has unknowingly had a placental bleed during pregnancy, causing fetal Rh(D) positive blood to mix with the mother's. If the mother has previously had a miscarriage or received a transfusion where Rh(D) positive blood was used, it is very likely that, if an adequate dose of anti-D was not administered at the time, her blood will contain Rh(D) antibodies.

PLEASE NOTE: A placental bleed (feto-maternal hemorrhage (FMH)) can occur during any pregnancy but, before we go any further, I would like to explain why it is much more unlikely for a woman to develop Rhesus (Rh) problems during her first:

The first time the Rhesus immune system encounters Rh(D) positive blood cells, it produces antibodies (IgM class antibodies) that are capable of destroying them. However, these antibodies are too large to travel through the blood vessel linking mother and baby`s blood and cannot harm the unborn child.  They are only effective in removing the positive cells from the mother's own bloodstream. It is the second and subsequent times such positive cells are encountered that the immune system will begin to produce a different type of antibody (class IgG antibodies) and, each time this occurs these antibodies react more `angrily` than the time before. Even though the `linking' blood vessel is only one cell wide, and not even the fetal and maternal bloods can mix this way, these new antibodies are of a shape and size that can easily pass through it, from the mother`s bloodstream to the baby. So, if a woman expecting her first child has a placental bleed during the pregnancy, she will produce the larger antibodies which can only destroy the positive cells circulating in her own blood. She would only start producing the more harmful antibodies if she suffered a further placental bleed. However, this is possible and the same care should be taken during a first pregnancy as with a second or subsequent pregnancy.

When Rh(D) positive cells find their way into a negative bloodstream for the first time, they remain `unnoticed` for about three days. After this time, the D antigen contained in these cells begins to stimulate the immune system into producing antibodies against them. When a woman`s own immune system has been stimulated into producing these antibodies, she is described as having been sensitized, which means that the first larger (IgM class) antibodies have been produced to destroy the positive red cells circulating in her own bloodstream. The immune system then `lays in wait` for the next shower of such cells to be encountered, ie. during a next pregnancy, so that the immediate production of the more harmful (IgG class) antibodies can begin. This is when the woman becomes Rh(D) Iso-immune - immunized against Rh(D) positive cells, even if they belong to her unborn child. Although the amount present may decrease over a period of time, these antibodies will remain in her bloodstream throughout her life, waiting to destroy any future invasion of Rh(D) positive red cells.

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THE PURPOSE OF ANTI-RH(D) INJECTIONS

After delivery, a blood test is performed to determine whether the baby is Rh(D) positive or negative. If the baby is tested Rh(D) positive, the mother will be given an injection of specially prepared anti-Rh(D), within three days (72 hours), in order to help her own blood destroy all the positive blood cells released into the bloodstream after the placenta comes away from the womb. This way, the blood cells are destroyed before the three days are up and her own immune system is not provoked into producing its own anti-Rh(D). Antibodies are only harmful if produced by the mother - the small amount injected after delivery is only there to do the job of `mopping up` the positive blood cells before they get to the immune system - they disappear from the bloodstream after a time.

100 micrograms of anti-Rh(D) will protect a woman from around 4ml of fetal blood. If the fetal-maternal hemorrhage (FMH) is more than 4 ml, a higher dosage is calculated and administered.

PLEASE NOTE: An anti-Rh(D) injection given at delivery is not a vaccine and does not make a woman immune to Rhesus (Rh) disease, but, provided she is found to be free of antibodies at the time it is administered, it can ensure that the woman begins the next pregnancy clear of antibodies.

Some Rh(D) negative women receive injections of anti-Rh(D) during pregnancy - especially at around 28 and/or 34 weeks - these would help to prevent antibodies being produced if an unsuspected placental bleed were to then occur, or had already occurred within the preceding 72 hours of the injection.

The amount injected is effective unless an unusually high amount of fetal blood enters the maternal bloodstream, thus `using up` the injected antibodies. In this respect, blood tests are still necessary throughout pregnancy to make sure that all is still well.

Each doctor follows guidelines set out by his/her own practice so a woman may find that she is not offered this treatment. However, administering anti-Rh(D) during pregnancy has been proved beneficial and it would be wise for a woman to discuss this with her doctor if she has any concerns about the welfare of her baby.

PLEASE NOTE: It is highly recommended that an anti-D injection be given after any incident which could result in red Rh(D) positive cells becoming present in the mother`s bloodstream, whether this be medical intervention where Rh(D) blood has been used, a fall which may cause a placental bleed, or a miscarriage.

ALSO NOTE: If a woman already has antibodies present in her blood a further administration of anti-D would be pointless and completely ineffective.

Although anti-Rh(D) is extremely effective, it is specially prepared using donor blood possessing high amounts of antibodies, the widespread use of this treatment has led to a number of women becoming immunized against red cell antigens unrelated to the Rhesus factor which, in rare circumstances, could also cause problems during a pregnancy, as well as there being a delay in providing blood for the mother herself in an emergency. However, the risks involved are outweighed enormously by the benefits of anti-Rh(D) and the injection should not be refused unless a woman is certain that her blood already contains Rh(D) antibodies.

If a Rh(D) negative woman is thought to be carrying a Rh(D) positive baby whose blood group differs from her own, you might ask why it is that her own in-built mechanism for destroying other blood types does not eliminate these cells from her bloodstream (Allo-immunization) before the D antigen contained in the Rh(D) positive cells stimulates her into producing Rh antibodies. While this would be so for some women, each person`s blood reacts in so many different ways, that it should never be assumed that the cells have been destroyed in time (within 72 hours). It is, therefore, standard procedure that every Rh(D) negative

woman has an anti-Rh(D) injection after delivery when the baby is found to be Rh(D) positive, whatever her blood group.

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IMPORTANCE OF BLOOD TESTS

At the beginning of a pregnancy, a woman`s blood is tested for the Rh(D) factor and, if she is found to be Rh(D) negative, further tests will be performed throughout the pregnancy to ensure that her blood is not producing Rh antibodies against her baby`s blood (see Antibodies and Their Effects).

If a bleed from the placenta should occur at any time during pregnancy and the fetal blood is Rh(D) positive, this would result in antibodies being produced. This is why it is essential to keep a note of when blood tests are due and what the results are. If results have not been received within a week after the test is performed, they should be `chased up`  - blood tests have been known to go astray. And, if a blood test is missed, it is vital that another one be arranged as soon as possible.

These tests are set out at carefully planned intervals throughout pregnancy to ensure that, if any antibodies are found in the bloodstream, the baby will not have been affected by them to such a degree that it would present a life threatening situation. Rhesus (Rh) disease (also called Hemolytic disease or Erythroblastosis Fetalis) takes weeks rather than days to affect the unborn child, so there would be ample time to check on the baby`s welfare and act accordingly.

It is written in pregnancy booklets that a Rh(D) negative woman should not be left to continue her pregnancy past her due date. The reason behind this is that, after the last carefully planned blood test, it is expected that the baby will be born on or before that date and, rather than perform another blood test, the baby will be delivered and any problems dealt with. It seems that this is not common practice.

In this respect, a woman who has not delivered by her due date should ask that a blood test be performed to put her mind at rest. While her doctor may insist that this is not necessary, babies suffering from Rh(D) disease have been known to die at full term and, even though this is a rare occurrence, this simple precaution should be taken.

PLEASE NOTE: If a baby`s blood is Rh(D) negative, it will not contain the D antigen and, therefore, cannot stimulate the mother`s immune system into producing antibodies throughout pregnancy or at labor and an anti-D is not necessary. Also, any antibodies already present in the mother`s blood cannot harm the baby`s negative cells. However, unless it is 100% certain that the partner is also Rh(D) negative, there will be no way of knowing the baby`s Rh factor during pregnancy and regular blood tests are still of utmost importance.

A recently developed test to determine the Rh factor of the baby by testing the amniotic fluid has been proving very effective. However, this test is only performed if a woman is already Rh(D) Rhesus iso-immune and her partner is known to possess both a positive and negative gene (d/D or D/d). This development is quite recent, but has proved very accurate and, although further blood tests will be performed regularly, a woman who is found to be carrying a Rh(D) negative baby will most probably be allowed to proceed with her pregnancy as normal.

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TREATMENT

Rh(D) antibodies attack the baby`s positive blood cells by coating and bursting them (hemolyzing), causing the baby to become slowly more and more anemic - a baby affected in this way would be described as having Rhesus ( Rh) disease (also called Hemolytic Disease of the Newborn (HDN), Hyperbilirubinemia or Erythroblastosis Fetalis). Each time a red blood cell is destroyed, a substance called bilirubin is released into the amniotic fluid, which causes these waters to become increasingly yellowed as more positive cells are destroyed.

The term `Rhesus disease` may lead you to believe that the condition is an illness which could affect the mother`s health. This is not true - her Rh antibodies cannot attack her own negative blood cells and will lie dormant in the bloodstream, and even decrease, until they encounter the next invasion of Rh(D) positive cells which would contain the D antigen capable of stimulating her into producing more. The only implications of the disease are those described on these pages and the only harm is to the unborn child.

If a blood test reveals that a dangerously high level of Rh(D) antibodies are present in the mother`s bloodstream, an amniocentesis will be performed - a sample of the amniotic fluid is taken and run through a machine which determines the level of bilirubin - the higher the degree of yellowing, the more the baby is affected. The results are compared carefully to a special chart (Liley chart), which shows whether the degree of yellowing proves the baby to be at risk.

These tests will be performed by a specialist, to whom the woman will have been quickly referred and who deals with Rhesus disease on a very regular basis. He/she will decide what action to take depending on the degree of anemia. The results may show that the baby is not so anemic, that action needs to be taken at that time. However, the woman would be asked to return every two weeks, or at intervals specified by the specialist, to retest the waters and keep a close check on how the anemia is progressing.

If, however, the results of the amniocentesis are plotted as high or higher than a line on the chart, called the Liley line, this would indicate that the baby is at risk and a transfusion into the umbilical cord will be performed under local anesthetic, whereby Rh(D) negative blood cells will be used to replace the positive ones destroyed. The amount of blood cells needed is cleverly determined by testing a sample of blood taken, by needle, from the cord (cordocentesis), guided using ultrasound. These results are quickly analyzed and the transfusion is performed there and then, using the already inserted needle, to minimize risk factors. This method is very successful and is sometimes repeated at intervals throughout the pregnancy, depending on subsequent test results. However, there may be occasions where the specialist is unable to insert the needle into the cord, or where the baby is in a position where the needle poses a risk and, in these circumstances, the needle will be inserted into the baby's abdominal cavity and injected slowly. Instead of being transfused directly into the baby's circulation, the blood will be absorbed over a small period of time. The mother would have been asked to arrive at the hospital an hour or so earlier than the transfusion is scheduled, in order that a sample of her blood can be taken and tested. This process is called cross-matching and enables the hospital's Hematology Department to find the closest match of donor Rh(D) negative blood. Not only does the donor blood have to be Rh(D) negative, it also has to be screened for any antigens, other than those related to the Rhesus Factor, which would stimulate the mother's immune system into destroying the newly transfused cells.

Although the mother's Rh antibodies cannot attack the transfused blood, the cells will diminish after a time and another test will be required two weeks later, again, to determine the amount of negative cells the baby needs to replace the positive ones destroyed. Even though the mother's antibody level is still checked at each stage of the treatment, it will most definitely rise to an extremely high level after the first and further transfusions.

It may be felt that it would be safer to deliver the baby and manage the baby's condition more directly, especially if the woman is more than 32 weeks into her pregnancy and the baby is at risk of developing severe Hemolytic Anemia. This is a very carefully made decision and one that depends on which situation

would give the baby a better chance of survival. As Pediatric medicine has progressed to a very high standard, it is usually considered much safer to do this.  However, if transfusions proceed until later in the pregnancy, say, 35 weeks, this increases the chance of a successful delivery nearer to full term and lessens the need for blood exchanges and other treatments.

If the baby is born early due to this condition, a transfusion is performed immediately to replace the baby`s blood with negative blood cells which remain in the system for about 40 days. About 9g of the baby`s blood is withdrawn and replaced at a time. Rh(D) negative cells are used to ensure that they cannot be harmed while helping the baby`s system to perform normally, which they do quite efficiently. They give the baby time to produce new positive cells, supplying enough blood to keep vital organs in good working order while this takes place. These Rh(D) negative cells will not harm the baby`s own newly produced cells, as there is no immune system to back them up. The blood used for this purpose is normally O Rh(D) negative and is cross-matched in the same way, to ensure that the transfused cells have no antigens to which the baby`s blood will take exception. Within as little as 72 hours the antibodies passed to the baby from the mother will have been eliminated.

If the anemia does not progress to the level that would require transfusions into the womb and a transfusion is not required at delivery, a special UV-ray lamp (Bililight) will be placed over the baby to combat any jaundice present (phototherapy). Close monitoring will ensure that the baby`s condition remains satisfactory.

PLEASE NOTE: Since the object of an anti-Rh(D) injection, is to prevent a woman from becoming sensitized and so becoming Rh(D) Iso-immune, the procedure would never benefit a woman with this condition. She will have plenty of anti-Rh(D) being manufactured by her own immune system and the injected antibodies would simply join forces with those already resident.

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ISO-IMMUNIZATION AND FUTURE PREGNANCY

As the Rh(D) antibody can cross the placenta from around 12 weeks, it is assumed that a baby would begin to become affected by the antibodies already present in the mother`s bloodstream from this time forward. For subsequent pregnancies a woman who is Rh(D) Iso-immune will have her blood tested at this time to check the level of antibodies present in her blood. This is measured in International Units (I/U). Obviously, it would be preferable to have no antibodies at all but, unfortunately, this would not be the case. However, if the level is measured to be less than 5 I/U, no action will be taken and further blood tests will be performed frequently to check this level. If the antibody level rises above 5 I/U, an amniocentesis is performed and, since it is possible that the baby may be Rh(D) negative, extra fluid will also be taken and tested at the same time to determine the Rh factor. This will also be the case if the mother is known to already have a higher level of antibodies than 5 I/U. An amniocentesis will be performed, along with a test to determine the baby's Rh factor, if necessary, along with an antibody check.

For reasons unknown, the woman`s antibody level still fluctuates slightly in response to a Rh(D) negative baby - not to such a high degree as during a Rh(D) positive pregnancy and, of course, no harm would come to a Rh(D) negative child.

Throughout the rest of the pregnancy, tests are done at intervals specified by the specialist taking care of that particular case. The length of time between testing depends on the degree by which the baby is affected, but can be as often as every two weeks. Also taken into consideration are the results of blood tests performed on the mother to determine the level of Rh(D) antibodies in her blood, which will rise as a Rh(D) positive pregnancy progresses and will be plotted on a Liley chart (see `Treatment`). It is usually at around 20 weeks, or later, that any intervention in respect of a transfusion is necessary.

Regarding transfusions and delivery, the same applies as when a placental bleed occurs during pregnancy (see `Treatment`), except that everybody is already totally aware of the situation and ready for action straight away.

PLEASE NOTE: When a woman is found to be carrying Rh(D) antibodies, the pregnancy is never allowed to go past full term. Once she has been diagnosed has being Rh(D) Iso-immune, and the specialists become involved, they take NO chances and, as they deal with this condition everyday, they have become experts in their field, with overwhelming success rates.

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NEW TREATMENTS - TRIALS

A new treatment, whereby the mother is transfused with non-specific (normal) human antibodies, is currently being used in trials.

If the mother's partner is known to be heterozygous (has both negative and positive genes), the baby's Rhesus factor is determined by either chorionic villus sampling (CVS) at around 11-12 weeks or amniocentesis at around 12-14 weeks.  CVS is performed by taking a small sample of cells from the placenta, outside the amniotic sac and analyzing it.  This method is often used early into the pregnancy, as an amniocentesis cannot always be performed at this time and the results of a CVS are available within a few days - the results of an amniocentesis take a little longer.  If the baby is found to be Rh(D) positive, the mother will immediately receive a transfusion of these normal antibodies on a daily basis for one week, after which the transfusions will be administered weekly until around 28 weeks.  These transfusions take around 2 hours and are stopped immediately if the mother develops any adverse reaction to the treatment, such as a rash etc.  So far, the only common side effect reported has been an occasional headache just after treatment, which has not caused any further problems for the mother. The normal antibodies help to protect the baby's red blood cells from the mother's harmful Rh(D) antibodies.

It has been considered that a safer option would be to begin treatment without CVS and perform an amniocentesis a few weeks later, to determine the Rh factor of the baby.  This would be a decision that needs to be made between the specialist and the patient.

NOTE:  If the mother's partner is known to be homozygous (having only Rh(D) positive genes), she will automatically go ahead with the transfusions, as there will be no need for CVS.

The same routine checks are still used to monitor the baby throughout the pregnancy - ie. amniocenteses and the mother's antibody check, as this treatment is still only being carried out in trials.

At present, this treatment is only offered to women whose condition has become so severe that their baby could be at risk.  The trials have so far been very successful, in that a transfusion into the womb becomes necessary much later in pregnancy, if at all, giving the baby a far greater chance of survival.

Unfortunately, even though this treatment has been very successful in severe cases, it has not yet been clinically proven as a definite advantage and is, therefore, very expensive and not widely available as a result.  Until a much larger number of women participating in these trials have delivered successfully, it will be a long time before any significant benefits are seen.

Another recent success had been seen in China, where a blood test is performed on the mother, to determine the baby's Rh factor.  The immature genes from the baby are detected in her blood and analyzed.  This test has been unreliable in the first trimester (up to around 13 weeks) but very accurate during the last two trimesters.  The test will not be widely available for a while, but it is a real step forward.

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On Roman Numerals (the way to write)

The Romans were active in trade and commerce, and from the time of learning to write they needed a way to indicate numbers. The system they developed lasted many centuries, and still sees some specialized use today.
Roman numerals traditionally indicate the order of rulers or ships who share the same name (i.e. Queen Elizabeth II). They are also sometimes still used in the publishing industry for copyright dates, and on cornerstones and gravestones when the owner of a building or the family of the deceased wishes to create an impression of classical dignity. The Roman numbering system also lives on in our languages, which still use Latin word roots to express numerical ideas. A few examples: unilateral, duo, quadricep, septuagenarian, decade, milliliter.
The big differences between Roman and Arabic numerals (the ones we use today) are that Romans didn't have a symbol for zero, and that numeral placement within a number can sometimes indicate subtraction rather than addition.
Here are the basics:

I	The easiest way to note down a number is to make that many marks - little I's. Thus I means 1, II means 2, III means 3. However, four strokes seemed like too many....
V	So the Romans moved on to the symbol for 5 - V. Placing I in front of the V — or placing any smaller number in front of any larger number — indicates subtraction. So IV means 4. After V comes a series of additions - VI means 6, VII means 7, VIII means 8.
X	X means 10. But wait — what about 9? Same deal. IX means to subtract I from X, leaving 9. Numbers in the teens, twenties and thirties follow the same form as the first set, only with X's indicating the number of tens. So XXXI is 31, and XXIV is 24.
L	L means 50. Based on what you've learned, I bet you can figure out what 40 is. If you guessed XL, you're right = 10 subtracted from 50. And thus 60, 70, and 80 are LX, LXX and LXXX.
C	C stands for centum, the Latin word for 100. A centurion led 100 men. We still use this in words like "century" and "cent." The subtraction rule means 90 is written as XC. Like the X's and L's, the C's are tacked on to the beginning of numbers to indicate how many hundreds there are: CCCLXIX is 369.
D	D stands for 500. As you can probably guess by this time, CD means 400. So CDXLVIII is 448. (See why we switched systems?)
M	M is 1,000. You see a lot of Ms because Roman numerals are used a lot to indicate dates. For instance, this page was written in the year of Nova Roma's founding, 1998 CE (Common Era; Christians use AD for Anno Domini, "year of our Lord"). That year is written as MCMXCVIII. But wait! Nova Roma counts years from the founding of Rome, ab urbe condita. By that reckoning Nova Roma was founded in 2751 a.u.c. or MMDCCLI.
V	Larger numbers were indicated by putting a horizontal line over them, which meant to multiply the number by 1,000. Hence the V at left has a line over the top, which means 5,000. This usage is no longer current, because the largest numbers usually expressed in the Roman system are dates, as discussed above.

Treatment for Hemophilia / Haemophilia

Up to a few decades ago a considerable proportion of patients with hemophilia died prematurely because of hemophilia. Tragically, many deaths were the result of childhood injury or surgery. Over the last forty years treatment has advanced so much that the vast majority of patients today are expected to live long and active lives.

The main breakthrough in treatment occurred when coagulation factor deficiencies linked to hemophilia could be identified and then replaced, using products derived from human blood.

In the past patients used to receive whole blood or plasma infusions to control episodes of bleeding. Even though this helped, levels of clotting factors, especially factors VIII and IX, never reached the levels required for really effective blood coagulation, nor could these levels be sustained - in other words, serious bleeding was only partly treated.

Cryoprecipitate, made through the cold precipitation of frozen plasma from1965 onwards, was the first really effective treatment for hemophilia A. Freeze-dried concentrates made from human plasma containing the right levels of Factors VIII and IX became available in the late 1960s and early 1970s. Being able to keep the treatment at home and use it as required meant that patients could travel, leave the home, go to work, and enjoy a level of independence. However, a large number of patients subsequently became infected with blood-borne pathogens, such as hepatitis B, hepatitis C and HIV.

From the mid 1980s rigorous donor selection and viral inactivation procedures reduced the risk of blood-borne viral transmission to nearly zero. During the 1990s it became possible to prepare synthetic (recombinant) factors, using specially prepared mammalian cells and these recombinant concentrates are now widely used.

Hemophilia treatment will mainly depend on its severity and for patients with Hemophilia A or B involves clotting factor replacement therapy. There are two approaches:

• On demand - giving treatment to stop prolonged bleeding when it occurs. This is more common in the management of patients with mild hemophilia.
• Preventative treatment (prophylaxis) - medication to prevent bleeding episodes, and subsequent complications, such as joint and/or muscle damage. More commonly used for patients with moderate or severe hemophilia.

Clotting factor concentrates

Clotting factor concentrates can be made in two different ways:

• Plasma-derived clotting factors - prepared from the plasma of donated human blood.
• Recombinant clotting factors - the first generation of recombinant products use animal products in the culture medium and had human albumin (a human blood product) added as a stabiliser. Second generation products use animal-derived materials in the culture medium but do not have added albumin and instead use sucrose or other non-human derived material as a stabiliser. Third generation clotting factors have no albumin present at any stage of their preparation. Mouse monoclonal antibodies have been routinely used in the purification of coagulation factors for many years but a recently licensed recombinant factor VIII employs a synthetic ligand for this step. This has resulted in the production of the first factor VIII concentrate to be free of all exogenous human and animal protein, a goal which was reached for hemophilia B when the first recombinant factor IX was licensed in 1997.

Desmopressin (DDAVP)(for mild hemophilia A)

This medication is a synthetic hormone which encourages the body to produce more of its own Factor VIII. It is unsuitable for patients with hemophilia B and those with severe hemophilia A. In patients with milder forms of hemophilia A, factor VIII replacement therapy may be necessary, especially for severe bleeds, or after serious injury or major surgery.

RICE (Rest, Ice, Compression, Elevation)

RICE is a treatment many health care professionals recommend for joint bleeds. It also reduces swelling and tissue damage when used together with clotting factor concentrates.

Administering clotting factor concentrates

The medication is injected into a vein - generally in the back of the hand or at the crook of the elbow. Initial treatments are usually administered by a doctor or nurse at a hospital or clinic. Most adults can learn how to do this themselves, which means they can stop bleeding rapidly and effectively wherever they are.

If the patient is a child the parents or caregivers (UK/Ireland/Australia: carers) can learn how to administer treatment. The majority of very young patients can receive most of their treatment at home.

If a patient is finding it hard to access a suitable vein, or if intensive treatment is required, a port-a-cath, or an external catheter called a Broviac or Hickman line can be placed surgically into a vein, allowing factor replacement therapies to be given, and blood to be drawn easily for routine emergency tests. The use of such catheters can be complicated by infection and blockage and they have to be used with great care.

Treating bleeds

Bleeding episodes (bleeds) are an inevitable complication for patients with hemophilia A and B, even for patients with mild forms. As the underlying problem is one of prolonged bleeding, rather than rapid bleeding, they often appear not to be medical emergencies.
If a person with hemophilia experiences any of the following he should seek immediate skilled medical help:

• There is an injury to the neck, mouth, tongue, face or eye.
• There is a severe blow to the head.
• Bleeding is heavy or persistent.
• There is severe pain or swelling in any part of the body.
• An open wound requires stitching.

Most other bleeds, such as joint/muscle bleeds, small injuries and cuts that do not require stitches, and nosebleeds are generally treated at home, but patients should always seek the advice of a healthcare professional when in doubt. Any treatment will be more effective if it is started early.

Storing treatment

Factor concentrates should usually be stored in a refrigerator but are stable at room temperature for quite long periods. They should not be frozen as this may damage the vials or syringes. Some may be taken out for travel but should ideally be kept in a cool bag. Read instructions on product storage. If you are unsure, check with a health care professional or qualified pharmacist.

Inhibitors

Approximately 30% of people with severe hemophilia A develop antibodies to transfused factor VIII, usually shortly after their first few treatments. These antibodies (also called inhibitors) prevent the factor VIIII treatment working properly. It is often the case that, after a while, the inhibitors disappear and only about 10% or less of people with severe hemophilia A will suffer from long term inhibitors. In recent years it has become possible to prevent inhibitors becoming persistent through immune tolerance induction therapy. Where inhibitors do not respond to this approach alternative treatments are available.

Inhibitors rarely develop in mild hemophilia A or in hemophilia B of any severity.

Hemophilia Symptoms and Diagnosis

What are the symptoms of hemophilia?

Hemophilia symptoms vary, depending on the degree of blood clotting factor (coagulation factor) deficiency and they also depend on the nature of any injury.
Three levels of hemophilia are recognized, according to the level of clotting factor amounts in the blood. These are often expressed as percentages of normal:

• Above 5% - mild hemophilia
• 1% to 5% - moderate hemophilia
• Less than 1% - severe hemophilia

Mild hemophilia

People with inherited mild hemophilia may not have any symptoms until an event occurs which wounds the skin or tissue, such as a dental procedure or surgery, and results in prolonged bleeding. In societies where male circumcision is carried out soon after birth, mild hemophilia will be detected earlier. Joint bleeding is uncommon.

Moderate hemophilia

Those with inherited moderate hemophilia will be noticeable early on. The child will bruise easily and may also experience internal bleeding symptoms, especially around the joints, and after a blow or a fall. Bleeding that occurs inside a joint is usually referred to as a joint bleed.
Symptoms of a joint bleed:

• Tingling sensation in the joint
• Pain in the joint
• Irritation in the joint

If left untreated, the patient may eventually experience:

• More severe pain in the joint
• Joint stiffness
• The affected area becomes swollen, tender and hot

Joint bleeds most commonly affect the:

• Ankles
• Knees
• Elbows
   ...and may less commonly affect the shoulders, hips or other joints.

Any surgical intervention, circumcision, dental procedure or injury will result in prolonged bleeding in a person with hemophilia.

Severe hemophilia

Symptoms are similar to those found in moderate hemophilia, but occur more frequently and are usually more severe.

A child with severe hemophilia will often bleed for no apparent reason, often referred to as spontaneous bleeding. Most commonly, in early childhood from about 18 months of age, the nose or mouth start to bleed or apparently spontaneous bruises appear, particularly on the legs. Parents are sometimes suspected of causing non-accidental injury (deliberate harm) to their children.
Symptoms of hemophilia type bleeding may include:

• Several large or deep bruises
• Joint pain or swelling
• Unexplained bleeding or bruising
• Blood in feces (stools)
• Blood in urine
• Unexplained nosebleeds
• Unexplained gum bleeding
• Tightness in the joints

Intracranial hemorrhage (bleeding inside the skull)

About 1 in every 30 patients with hemophilia will have intracranial hemorrhage at least once during their lives. This should be treated as a medical emergency. Spontaneous intracranial hemorrhage is rare and in many cases bleeding inside the skull will be the result of a blow to the head.
Symptoms of intracranial hemorrhage include:

• A bad headache
• Vomiting
• Confusion
• Fitting (Convulsion)
• Loss of balance
• Slurred speech, or other speaking difficulties
• Stiff neck
• Vision problems
• Loss of coordination
• Some of the facial muscles do not work (sometimes all of them)

How is hemophilia diagnosed?

Prenatal testing - if a pregnant woman has a history of hemophilia, a hemophilia gene test can be done during pregnancy. A sample of placenta is removed from the uterus and tested. This test is known as a CVS (chorionic villus sampling) test.
Blood test - if a doctor suspects a child may have hemophilia a blood test can determine whether the patient has hemophilia A or B, and how severe it is. Blood tests can be performed from the time of birth onwards.

What is Coagulation? How does our blood clot?

Coagulation is a complex process by which the blood forms clots to block and then heal a lesion/wound/cut and stop the bleeding. It is a crucial part of hemostasis - stopping blood loss from damaged blood vessels. In hemostasis a damaged blood vessel wall is plugged by a platelet and a fibrin-containing clot to stop the bleeding, so that the damage can be repaired.
Coagulation involves a cellular (platelet) and protein (coagulation factor) component.
When the lining of a blood vessel (endothelium) is damaged, platelets immediately form a plug at the site of the injury, while at the same time proteins in the blood plasma respond in a complex chemical reaction, rather like a waterfall, to form fibrin strands which reinforce the platelet plug.
Primary hemostasis - when the platelets gather at the site of an injury to plug (block) it.
Secondary hemostasis - proteins (coagulation factors) act in a series of chemical reactions to strengthen the plug and allow healing to begin.

What is a platelet?

A platelet is a disc-shaped element in the blood that is involved in blood clotting. They aggregate (clump together) during normal blood clotting. They are classed as blood cells, but are in fact fragments of large bone marrow cells called megakaryocytes.

What is fibrin?

Fibrin is an insoluble protein involved in blood clotting. Fibrin is deposited around the wound in a form of mesh to strengthen the platelet plug. The whole thing dries and hardens (coagulates) so that the bleeding stops and the wound then heals. Fibrin is developed in the blood from a soluble protein, fibrinogen.
When platelets come into contact with damaged tissue thrombin is formed as a result of a series of chemical processes (coagulation cascade) that culminate in the formation of fibrin from fibrinogen.

Coagulation factors (clotting factors)

Coagulation factors are proteins, mostly manufactured by the liver. They were originally numbered in the order of their discovery, traditionally using Roman numerals from I-XIII. Some of the numbers such as III and VI are not used any more and in recent years, many proteins that affect blood clotting have been discovered but have been given a name rather than a number. When a blood vessel wall is damaged, or any kind of wound occurs, a complex set of chemical reactions involving these coagulation factors (and acting rather like a waterfall) takes place.
The final step of the cascade of chemical reactions is to convert fibrinogen - Factor I - into fibrin, forming a mesh which clumps platelets and blood cells into a solid clot, plugging the hole and stopping the bleeding. Patients with Hemophilia A have deficient levels of Factor VIII, while patients with Hemophilia B have deficient levels of Factor IX.

What Causes Hemophilia / Haemophilia?

People with hemophilia are born with it. It is caused by a fault in one of the genes that determine how the body makes blood clotting factor VIII or IX. These genes are located on the X chromosome.
To understand how hemophilia is inherited, it is important to learn about chromosomes.

What are chromosomes?

Chromosomes are blocks of DNA (deoxyribonucleic acid). They contain very detailed and specific instructions that determine:

• How the cells in a baby's body develop.
• What features the baby will have, including, for example, hair and eye color.
• Whether the baby is male or female.

In humans there are 23 pairs of chromosomes, including the sex chromosome pair. There are two types of sex chromosome:

• The X chromosome
• The Y chromosome

All humans have a pair of sex chromosomes:

• Males have an X + Y pair
• Females have an X + X pair
NB  Females do not have any Y chromosomes.

What chromosomes do we inherit from our parents?

• A Male inherits his
  
  • X chromosome from his mother
  • Y chromosome from his father
• A Female inherits
  
  • One X chromosome from her mother
  • One X chromosome from her father
  She does not inherit both X chromosomes from her mother. She has no Y chromosomes.

How can we calculate the risk of hemophilia in offspring?

(Before reading on, remember that the faulty gene is never on the Y chromosome. If it is present, it will be on the X chromosome.)

• Female (X + X_faulty) is a carrier, but does not have hemophilia. The “good” X chromosome allows the production of enough clotting factor to prevent serious bleeding problems.
• Male (Y + X_faulty) will develop hemophilia and can pass it on.

If the father has hemophilia and the mother has no faulty gene (is not a carrier):
Father (Y + X_faulty). Mother (X + X).

• There is no risk of inherited hemophilia in their sons because boys will inherit their X chromosome from the mother, not the father (they inherit the father's Y chromosome only, which does not have the faulty gene).
• All the daughters will be carriers but will not develop hemophilia although they will inherit the father's X chromosome, which has the faulty gene. However, their maternal X chromosome, which does not have the faulty gene, usually allows the production of enough clotting factor to prevent serious bleeding problems.

If the father does not have hemophilia and the mother has a faulty gene:
Father (Y + X). Mother (X + X_faulty).

• There is a 50% chance that sons will develop hemophilia because:
  
  
  • There is a 50% risk that a son will inherit his mother's X_faulty chromosome, plus his father's Y chromosome - he will have hemophilia.
  • There is a 50% chance he will inherit his mother's "good" X chromosome, plus his father's Y chromosome - he will not have hemophilia.
• There is a 50% chance that daughters will be carriers, (but no chance of developing hemophilia), because:
  
  
  • There is a 50% chance she will inherit her mother's X_faulty chromosome, making her a carrier.
• There is a 50% chance she will inherit her mother's "good" X chromosome, which would mean she would not be a carrier.

Approximately one third of patients with hemophilia have no family history of the disease, either because of new genetic mutations, or because previous affected generations either had daughters (who were carriers) or sons who died in early childhood from hemophilia or any other cause or who were not affected.

Types of Hemophilia / Haemophilia

Hemophilia A and Hemophilia B

There are two main types of hemophilia - Hemophilia A (due to factor VIII deficiency) and Hemophilia B (due to factor IX deficiency). They are clinically almost identical and are associated with spontaneous bleeding into joints and muscles and internal or external bleeding after injury or surgery.
After repeated bleeding episodes permanent damage may be caused to the joints and muscles that have been affected, particularly the ankles, knees and elbows.
Approximately 1 in 5,000 males is born with Hemophilia A, and 1 in 30,000 males is born with Hemophilia B. Hemophilia affects people of all races and ethnic origins globally. The conditions are both X-linked and virtually all sufferers of hemophilia are males. Female carriers may also bleed abnormally, because some have low levels of the relevant clotting factor.
People with hemophilia have a genetic mutation in the affected gene on the X chromosome, which results in reduced production of Factor VIII or IX and creates a bleeding tendency, because coagulation takes much longer than normal, thus making the clot weak and unstable
Approximately one third of patients with hemophilia have no family history of the disease, either because of new genetic mutations, or because previous affected generations either had daughters (who were carriers) or sons who died in early childhood from hemophilia or any other cause or who were not affected.

Acquired hemophilia

This is very rare. The patient develops the condition during his/her lifetime and it does not have a genetic or heritable cause. It occurs when the body forms antibodies that attack one or more blood clotting factors, (usually factor VIII), thus preventing the blood clotting mechanism from working properly. Patients may be male or female and the pattern of bleeding is rather different from that of classical hemophilia, the joints being rarely affected. The disorder is particularly associated with old age and occasionally complicates pregnancy.

What is Hemophilia? What is Haemophilia?

Hemophilia is a group of inherited blood disorders in which the blood does not clot properly.
Hemophilia is the standard international spelling, also known as haemophilia in the UK, other translations include: hémophilie, hemofilie, hemofili, hemofilia, hämophilie, emofilia. We will use the standard international spelling for the purpose of this section.
Bleeding disorders are due to defects in the blood vessels, the coagulation mechanism, or the blood platelets. An affected individual may bleed spontaneously or for longer than a healthy person after injury or surgery.
The blood coagulation mechanism is a process which transforms the blood from a liquid into a solid, and involves several different clotting factors. The mechanism generates fibrin when it is activated, which together with the platelet plug, stops the bleeding.
When coagulation factors are missing or deficient the blood does not clot properly and bleeding continues.
Patients with Hemophilia A or B have a genetic defect which results in a deficiency in one of the blood clotting factors.
Queen Victoria was a carrier and passed the mutation to her son Leopold, and through several of her daughters to members of the royal families of Spain, Russia, and Germany.
Tsarevich Alexei Nikolaevich, son of Nicholas II (Russia) suffered from hemophilia and was a descendant of Queen Victoria - Rasputin was successful in treating his hemophilia, it was claimed.

Why do not we celebrate Valentine?

Someone may ask: why do we Muslims not celebrate this festival?

This question may be answered in several ways:
1. In Islam, the festivals are clearly defined and well established, and no additions or subtractions may be accepted. They are an essential part of our worship and there is no room for ijtihaad or personal opinion. They have been prescribed for us by Allah and His Messenger (peace and blessings of Allah be upon him). Ibn Taymiyah (may Allah have mercy on him) said: "Festivals are part of the laws, clear way and religious ceremonies of which Allah says (interpretation of the meaning): {To each among you, We have prescribed a law and a clear way…} [al-Maa’idah 5:48] {For every nation We have ordained religious ceremonies which they must follow’} [al-Hajj 22:67] It is thus like the qiblah (direction faced in prayer), prayer and fasting. So there is no difference between joining them in their festival and joining them in their other rituals. Agreeing with the whole festival is agreeing with kufr. Agreeing with some of their minor issues is the same as agreeing with them in some of the branches of kufr. Festivals are the most distinctive things by which religions are told apart, so whoever celebrates their festivals is agreeing with the most distinctive rituals of kufr. Undoubtedly, going along with them in their festivals may in some cases lead to kufr. Dabbling in these things, at the very least, is a sin. The Prophet (peace and blessings of Allah be upon him) referred to the fact that every nation has its own festivals when he said: {Every nation has its own Eid and this is our Eid} (al-Bukhaari , 952, Muslim, 1892).” (Al-Iqtidaa’, 1/471-472)
Because Valentine’s Day goes back to Roman times, not Islamic times, this means that it is something which belongs exclusively to the Christians, not to Islam, and the Muslims have no share and no part in it. If every nation has its own festivals, as the Prophet (peace and blessings of Allah be upon him) said – {Every nation has its Eid} (Narrated by al-Bukhaari and Muslim) Thus, this means that every nation should be distinguished by its festivals. If the Christians have a festival and the Jews have a festival, which belongs exclusively to them, then no Muslim should join in with them, just as he does not share their religion or their direction of prayer.
2. Celebrating Valentine’s Day means resembling or imitating the pagan Romans, then the Christian People of the Book in their imitation of the Romans in something that was not a part of their religion. If it is not allowed to imitate the Christians in things that really are part of their religion – but not part of our religion – then how about things which they have innovated in their religion in imitation of idol-worshippers?!
Imitating the kuffaar in general – whether they are idol-worshippers or People of the Book – is haraam, whether that imitation is of their worship – which is the most serious form – or of their customs and behaviour. This is indicated by the Qur’aan, Sunnah and ijmaa’ (scholarly consensus):
(i) From the Qur’an: Allah says (interpretation of the meaning): {And be not as those who divided and differed among themselves after the clear proofs had come to them. It is they for whom there is an awful torment} [Al ‘Imraan 3:105]
(ii) From the Sunnah: the Prophet (peace and blessings of Allah be upon him) said: {Whoever imitates a people is one of them.} (Narrated by Ahmad, 2/50; Abu Dawood, 4021)
Shaykh al-Islam (Ibn Taymiyah) said: “This hadeeth at the very least indicates that it is haraam to imitate them, although the apparent meaning implies that the one who imitates them is a kaafir, as Allah says (interpretation of the meaning): {And if any amongst you takes them (as Awliyaa’ [friends and helpers]), then surely, he is one of them} [al-Maa’idah 5:51].” (al-Iqtidaa’, 2/722-725)
(iii) With regard to ijmaa’, Ibn Taymiyan narrated that there was agreement that it is haraam to imitate the kuffaar in their festivals at the time of the Sahaabah (may Allah be pleased with them), and Ibn al-Qayyim narrated that there was scholarly consensus on this point. (See al-Iqtidaa’, 1/454; Ahkaam Ahl al-Dhimmah, 2/722-725)
Allah has forbidden imitation of the kuffaar; He has described it as hateful and has warned against the consequences of that, in many aayahs, on many occasions, and in various ways, especially imitation of the kuffaar. Sometimes He does that by forbidding following them or obeying them; sometimes by warning against them or being deceived by their plots, following their opinions, or being influenced by their actions, conduct or attitude.
Sometimes, He does that by mentioning some of their characteristics that will put the believers off from them and from imitating them. Most of the warnings in the Qur’aan refer to the Jews and hypocrites (munaafiqeen), then the People of the Book in general and the mushrikeen. Allah tells us in the Qur’aan that imitating and obeying the kuffaar may constitute riddah (apostasy). Allah also forbids following them, obeying them, or following their whims and desires and bad characteristics.
Prohibition of imitating the kuffaar is one of the basic principles of sharee’ah. Allah sent His Messenger with guidance and the true religion so that it might prevail over all other religions, and Allah has perfected His religion for mankind:
{This day, I have perfected your religion for you, completed My Favour upon you, and have chosen for you Islam as your religion} [al-Maa’idah 5:3 – interpretation of the meaning].
Allah has made Islam cover all (human) interests at all times and in all places and for all people. So there is no need to adopt the ways of the kuffaar or imitate them. Imitation causes defects in the Muslim personality, such as feelings of inadequacy, inferiority, weakness and defeatism, then it leads to shunning and keeping away from the path and laws of Allah. Experience has shown that admiration for the kuffaar and imitation of them causes people to love them, have complete faith in them and take them as friends and helpers, and to reject Islam and its people, its heroes, its legacy and values, and become ignorant of all of that.
3. The purpose of Valentine’s Day in these times is to spread love between all people, believers and disbelievers alike. Undoubtedly it is haraam to love the kaafirs. Allah says (interpretation of the meaning): {You (O Muhammad) will not find any people who believe in Allah and the Last Day, making friendship with those who oppose Allah and His Messenger (Muhammad), even though they were their fathers or their sons or their brothers or their kindred (people)…} [al-Mujaadilah 58:22]
Shaykh al-Islam Ibn Taymiyah (may Allah have mercy on him) said: “Allah tells us that there is no believer who takes a kaafir as a close friend. Whoever takes a kaafir as a close friend is not a believer. Outward imitation may be taken as a sign of love, so it is haraam.” (al-Iqtidaa’, 1/490).
4. The love referred to in this festival ever since the Christians revived it is romantic love outside the framework of marriage. The result of that is the spread of zinaa (fornication and adultery) and immorality. Hence the Christian clergy opposed it at some stage and abolished it, then it came back again. Most of the young people celebrate it because it lets them fulfil their desires, without thinking of the issues of imitation and resembling that are involved. Look at this tragedy, where they go so far as to commit major sins such as zinaa and the like, by imitating the Christians in something which is part of their worship and which may even be kufr. Some people may wonder, and say, you mean to deprive us of love, but in this day and age we express our feelings and emotions – what is so wrong with that?
We say:
Firstly:
It is a mistake to confuse what they call the day with what the real intentions are behind it.
The love referred to on this day is romantic love, taking mistresses and lovers, boyfriends and girlfriends. It is known to be a day of promiscuity and sex for them, with no restraints or
restrictions… They are not talking of pure love between a man and his wife or a woman and her husband, or at least they do not distinguish between the legitimate love in the relationship between husband and wife, and the forbidden love of mistresses and lovers. This festival for them is a means for everyone to express love.
Secondly:
Expression of feelings and emotions is not a justification for the Muslim to allocate a day for celebration based on his own thoughts and ideas, and to call it a festival, or make it like a festival or Eid. So how about when it is one of the festivals of the kuffaar? In Islam, a husband loves his wife throughout the year, and he expresses that love towards her with gifts, in verse and in prose, in letters and in other ways, throughout the years – not just on one day of the year.
Thirdly:
There is no religion which encourages its followers to love and care for one another more than Islam does. This applies at all times and in all circumstances, not just on one particular day. Indeed, Islam encourages us to express our emotions and love at all times, as the Prophet (peace and blessings of Allah be upon him) said: {If a man loves his brother, let him tell him that he loves him.} (narrated by Abu Dawood, 5124; al-Tirmidhi, 2329; it is saheeh).
And he said: {By the One in Whose hand is my soul, you will not enter Paradise until you truly believe, and you will not truly believe until you love one another. Shall I not tell you of something that, if you do it, you will love one another? Spread (the greeting of) salaam amongst yourselves.} (Narrated by Muslim, 54)
Fourthly:
Love in Islam is more general and more comprehensive; it is not restricted only to one kind of love, that between a man and a woman. There are many more kinds of love. There is the love of Allah, love of His Messenger (peace and blessings of Allah be upon him) and his companions (may Allah be pleased with them), love for good and righteous people, love and support for the religion, love of martyrdom for the sake of Allah. There are many kinds of love. It is a dangerous mistake to restrict this broad meaning to this one kind of love.
Fifthly:
What these people think, that love before marriage is a good thing, is wrong, as has been proven in studies and by real-life experience. In a study conducted by the University of Cairo, on what they called “love marriage” and “traditional marriage”, the following was stated:
In marriages which came after a love story, 88% of cases ended in failure, i.e., the success rate was not more than 12%. But in cases of what the study calls traditional marriage, 70% were successful. In other words, the success rate in marriages described as traditional was six times more than those described as “love marriages”. (Risaalah ila Mu’minah, p. 255).
Now let us look at the state of affairs in western societies where Valentine’s Day is celebrated, and ask, what is the state of marriage relationships in those societies, and do these celebrations have any positive effect on interactions between husbands and wives?
Their own studies and statistics show the following:
1- In an American study done in 1407 AH/1987 CE, it states that 79% of men beat their womenfolk, especially if they are married…! (al-Qabas newspaper, 15/2/1988).
2- A study carried out by the National American Office for Mental Health states the following:
- 17% of women who go to emergency rooms are victims of beatings by their husbands or boyfriends.
- 83% of those who have previously been admitted to hospital at least once for treatment of injuries, were admitted as a result of beating. The study added that there are more women who do not go to hospital for treatment, but deal with their injuries at home.
3- In a report of the Central American Agency for Examination [FPT] it states that every 18 seconds there is a woman who is beaten by her husband somewhere in America.
4- American Time magazine stated that around 4,000 wives out of approximately 6 million who are beaten die as a result of that beating.
5- In a German study it said that no less that 100,000 women annually are exposed to acts of physical or psychological abuse on the part of their husbands or the men they live with. The real figure may exceed one million.
6- In France, approximately 2 million women face beatings.
7- In Britain, in an opinion poll in which 7,000 women took part, 28% of them said that they had been subjected to attacks by their husbands and boyfriends.
So how can we believe that Valentine’s Day is of any benefit to married couples? The truth is that it is a call for more permissiveness and immorality, and the forming of forbidden relationships. The husband who sincerely loves his wife does not need this holiday to remind him of his love. He expresses his love for his wife at all times and on all occasions.

The Muslim’s attitude towards Valentine’s Day   
From the above discussion, the Muslim’s attitude towards this holiday should be clear:
(1) He should not celebrate it, or join others in their celebrations of it, or attend their celebrations, because of the evidence quoted above which shows that it is forbidden to celebrate the festivals of the kuffaar.
Al-Haafiz al-Dhahabi (may Allah have mercy on him) said: “If the Christians have a festival and the Jews have a festival, which belongs only to them, then the Muslim should not join them in that, just as he does not join them in their religion or their direction of prayer.” (Tashabbuh al-Khasees bi Ahl al-Khamees, al-Hikmah magazine, 4/193).
Because one of the basic principles of the pious predecessors was al-walaa’ wa’lbaraa’ (loyalty and friendship vs. disavowal and enmity), it is obligatory for everyone who says Laa ilaaha ill-Allah Muhammad Rasool Allah to follow this principle. So he should love the believers and he should hate the disbelievers, oppose them, and be different from them. He should know that that will bring immeasurable benefits, just as imitating them causes far greater harm. In addition to that, when the Muslims imitate them it makes the kuffaar happy and fills their hearts with joy, and it leads the Muslims to love the kuffaar in their hearts. If any Muslim girl who celebrates this holiday because she sees Margaret or Hilary or whoever doing so, this undoubtedly reflects the fact that she is following them and approves of their behaviour. But Allah says (interpretation of the meaning):
{O you who believe! Take not the Jews and the Christians as Awliyaa’ (friends, protectors, helpers), they are but Awliyaa’ of each other. And if any amongst you takes them (as Awliyaa’), then surely, he is one of them. Verily, Allah guides not those people who are the Zaalimoon (polytheists and wrongdoers and unjust)} [al-Maa’idah 5:51]
One of the bad effects of imitating them is that this makes it look as if there are more of them, as if they have more supporters and followers. How can it be appropriate for a Muslim who recites in every rak’ah, {Guide us to the Straight Way, The way of those on whom You have bestowed Your Grace, not (the way) of those who earned Your Anger, nor of those who went astray.} [al-Faatihah 1:6-7 – interpretation of the meaning], to ask Allah for guidance to the Straight Path of the believers and to keep him away from the path of those who have earned His anger and of those who went astray, then go and follow their path by choice and willingly?
Statistics indicate that Valentine’s Day is second only to Christmas in popularity. So it is clear that the Feast of Love is one of the festivals of the Christians and that it is second only to the festival of Christmas, the celebration of the birth of the Messiah. So it is not permissible for Muslims to join in the celebrations of this date, because we are commanded to differ from them in their religion, customs and other things that belong exclusively to them, as is stated in the Qur’aan and Sunnah and scholarly consensus.
(2) He should not help the kuffaar in their celebrations, because it is one of the rituals of kufr, so helping them and approving of what they do is helping them to manifest kufr and make it prevail, and approving of it. The Muslim’s religion does not allow him to approve of kufr or help others to manifest it and make it prevail. Hence Shaykh al-Islam Ibn Taymiyah (may Allah have mercy on him) said: “It is not permissible for the
Muslims to imitate them in anything that is specifically part of their festivals, whether it is food, clothing, bathing, lighting fires, or changing a custom of daily life or worship… To sum up, they should not do any of the specific rituals of their (the kuffaar’s) festival on that day; rather the day of their festival should be just another ordinary day for the Muslim.” (Majmoo’ al-Fataawa, 25/329)
(3) He should not help any Muslims who celebrate it. Rather it is obligatory to denounce them, because for the Muslims to celebrate the festivals of the kuffaar is an evil action which must be denounced. Shaykh al-Islam (Ibn Taymiyah) said: “Just as we should not imitate them in their festivals, so too we should not help a Muslim to do that; rather, he should be told not to do that.” (al-Iqtidaa’, 2/519-520)
Based on what Ibn Taymiyah said, it is not permissible for Muslim businessmen to deal in gifts for Valentine’s Day, whether they are particular kinds of clothes, red roses, or whatever. Similarly, it is not permissible for the one who is given a gift on this occasion to accept it, because by accepting it, he is showing approval of this holiday.
One of the daa’iyahs said: we went to a flower shop in one of the Muslim countries and we were shocked to find it completely prepared for this occasion, with red carpets at the entrance, red placards and red decorations. We were met by one of the people who worked there, and we asked him why they had done so much to decorate the place for this occasion.
He said that these preparations had begun early, and that there had been very many orders… Then he told us that he had been amazed by that, because he was a new Muslim who had left Christianity. He had known about that before he became Muslim, so how come his customers were Muslims and not Christians?! Other shops ran out of red roses, which were being sold at high prices. When one of the female daa’iyahs entered upon the female students who were gathered in the lecture hall, she was dismayed to find them all carrying something red. One had a red rose, another had a red scarf, or a red handkerchief, or a red bag, or red socks… Alas for the Muslim girls!
Among the things that have been seen among the Muslims on this holiday:
1- All the female students agreeing with their friends to tie a red ribbon on the right wrist.
2- Wearing something red (a blouse, hair clip, shoes…). This reached such an extent last year that when we entered the classroom we found most of the students wearing it, as if it was a uniform.
3- Red balloons on which are written the words “I love you”. They usually bring these out at the end of the school day, in an area far from where the teachers can see them.
4- Writing names and hearts on their hands, or just initials.
5- Red roses are widespread on this day. Groups of girls entered their lecture rooms on February 14, each of them wearing something red, with red heart-shaped stickers on their faces, wearing red make-up. They started to exchange red-colored gifts and kiss one another warmly. This happened in more than one university in the Muslim world, even in an Islamic university. In other words they were celebrating Saint Valentine’s Day.
On that day, secondary schools (high schools) were astonished by the large numbers of female students who brought red roses of the finest quality, colored their faces with red cosmetics, wore red earrings, and started to exchange gifts and warm greetings, in celebration of this day. Al-Mawsoo’ah al-‘Arabiyyah (the Arabic Encyclopedia) says that there are special customs for Valentine’s Day, such as printing love poems on cards to be given to relatives and those whom one loves. Some of them draw funny pictures on these cards, and the most common phrase written on them is “be my Valentine”. Parties are often held during the day, where they dance in their fashion. The Europeans still celebrate this holiday. In Britain, sales of flowers reached 22 million pounds. More chocolate is consumed on this day, and companies offer free messages on their Web sites to advertise those sites.
Valentine’s Day has come to a number of Arab and Muslim countries, and has even reached the heartland of Islam (the Arabian Peninsula). It has reached societies which we had thought far removed from this insanity. In Riyadh the price of roses has risen in a crazy manner, so that a single rose costs 36 riyals (10 dollars), whereas before this day it cost 5 riyals. Gift shops and card shops compete in designing cards and gifts for this occasion, and some families hang up red roses in the windows of their homes on this day.
In some of the Gulf countries, shopping centres and hotels have organized special celebrations of Valentine’s Day. Most of the stores and business places are covered with red. One of the finest Gulf hotels was full of balloons and dolls. Following the customs of the Feast of Love and the pagan myths, the restaurant put on a dramatic production with “Cupid”, the idol of love in the Roman myths, nearly naked and carrying a bow and arrow.
He and his cohorts were looking to select “Mr. & Mrs. Valentine” from among the people present. Less expensive restaurants also celebrated this day in their own way. Some stores replaced their regular plates with heart-shaped plates, used red tablecloths and linens, and put a red rose on each table for the man to present to his beloved.
The latest Valentine’s Day craze was started by the owner of a gift-shop in Kuwait. He imports (live) French rabbits which are small and have red eyes. He puts a necktie around the neck of each rabbit, and puts it in a small box to be given as a gift! We must oppose these things by all possible means. The responsibility rests with us all.
(4) We should not accept congratulations on Valentine’s Day, because it is not a holiday or an Eid for the Muslims. If the Muslim is congratulated on this occasion, he should not return the congratulations. Ibn al-Qayyim (may Allah have mercy on him) said: “With regard to congratulating others with the congratulations used by the kuffaar on such occasions, it is haraam by scholarly consensus, such as congratulating them on the occasion of their festivals or fasts, wishing them a blessed festival, etc. Even if the one who says this is free of kufr, it is still haraam. It is like congratulating someone for prostrating to the cross. It is even worse with Allah and more hated by Him than congratulating someone for drinking alcohol, or committing murder or adultery, etc. Many of those who have no respect for religion do that, and they do not realize the abhorrence of their actions. Whoever congratulates a person for sin, innovation (bid’ah) or kufr exposes himself to the hatred and wrath of Allah.” (Ahkaam Ahl al-Dhimmah, 1/441-442)
(5) We must explain the true nature of this holiday and other festivals of the kuffaar to those Muslims who have been deceived by them, and explain to them that it is essential for the Muslim to be distinguished by his religion and to protect his belief (‘aqeedah) from anything that may damage it. This should be done out of sincerity towards the ummah and in fulfilment of the command to enjoin what is good and forbid what is evil.
Fatwas of Muslim scholars concerning Valentine’s Day
The Fatwa of Shaykh Muhammad ibn Saalih al-‘Uthaymeen (may Allah have mercy on him).
Question:
In recent times the celebration of Valentine’s Day has become widespread, especially among female students. This is one of the Christian holidays. They wear all red clothes, including their shoes, and they exchange red flowers… We hope that you can tell us the ruling on celebrating such holidays. What do you advise the Muslims to do with regard to such things? May Allah keep you and take care of you.
He replied:
Celebrating Valentine’s Day is not permitted for several reasons:
1 – It is an innovated celebration which has no basis in sharee’ah.
2 – It calls for people to keep their hearts and minds busy with these foolish things that go against the guidance of the pious predecessors (may Allah be pleased with them), so it is not permitted on this day to do any of the customs associated with that holiday, whether that be connected to food, drink, clothing, exchanging gifts or anything else. The Muslim should be proud of his religion and not be so weak of character that he follows everyone who makes a noise. I ask Allah to protect the Muslims from all temptations, visible and invisible, and to take care of us and give us strength. And Allah knows best.
The Fatwa of Shaykh ‘Abd-Allah ibn ‘Abd al-Rahmaan ibn Jibreen concerning celebrating this day:
He was asked: the celebration of the so-called Feast of Love (Valentine’s Day) has become widespread among our boys and girls. This (Valentine) is the name of a saint who is venerated by the Christians, and this day is celebrated every year on February 14. They exchange gifts and red roses, and they wear red clothes. What is the ruling on celebrating this day or exchanging gifts on this day? May Allah reward you with good.
He answered:
Firstly, it is not permissible to celebrate such innovated festivals, because this is a newly-invented innovation (bid’ah) which has no basis in sharee’ah. So it is included in the hadeeth
of ‘Aa’ishah (may Allah be pleased with her), who said that the Prophet (peace and blessings of Allah be upon him) said: “Whoever innovates something in this matter of ours (i.e., Islam) which is not part of it, will have it rejected” – i.e., it will be thrown back upon the one who innovated it.
Secondly, this involves imitating and resembling the kuffaar in venerating that which they venerate and respecting their festivals and holidays, and imitating them in some of their religious practices. In the hadeeth it says, {Whoever imitates a people is one of them.}
Thirdly, the things that result from that, such as partying, idle play, singing, music, insolence, impertinence, unveiling, wanton display, mixing of men and women, and the appearance of women before non-mahrams, etc., are all things which are haraam, or are means which lead to immorality. So it should not be justified as an excuse for relaxation and entertainment, or claims that they will not overstep the mark, because that is not right. The one who cares about himself should keep away from sin and all that leads to it.
On this basis, it is not permissible to sell these gifts and roses, if one knows that the purchaser will celebrate these holidays, give them as gifts or otherwise use them to honor these days, so that the vendor will not be sharing in the guilt of the one who does this innovated action. And Allah knows best.
The Fatwa of the Standing Committee
The Standing Committee was also asked a question about this holiday:
Some people celebrate the fourteenth day of February of each Christian year as the Day of Love (Valentine’s Day), where they exchange gifts of red roses and wear red clothes, and congratulate one another. Some the bakeries make sweets that are red in color, with hearts drawn on them, and some stores have advertisements for their products that are especially for this day. What is your opinion?
The Committee replied:
It is haraam for the Muslim to help with this festival or any other haraam celebration in any way, be it food, drink, buying, selling, manufacturing, corresponding, advertising or in any other way, because all of that constitutes helping one another in sin, transgression and disobedience towards Allah and His Messenger, and Allah says (interpretation of the meaning):
{Help you one another in Al-Birr and At-Taqwa (virtue, righteousness and piety); but do not help one another in sin and transgression. And fear Allah. Verily, Allah is Severe in punishment.} [al-Maa’idah 5:2]
So the Muslim must adhere to the Qur’aan and Sunnah in all his affairs, especially at times of fitan (temptation and tribulation) and when corruption is widespread. He should be smart and be careful to avoid falling into the misguidance of those who have earned the anger of Allah and of those who went astray, and of the evildoers who hope not for reward from Allah and do not show any respect towards Islam. The Muslim should seek refuge with Allah and ask for His guidance and for help to adhere steadfastly to it, because none can guide except Allah and none can make us remain steadfast except Him. And Allah is the Source of strength. May Allah bless our Prophet Muhammad and his family and companions, and grant them peace.
Al-Lajnah al-Daa’imah li’l-Buhooth al-‘Ilmiyah wa’l-Iftaa’
Finally, we offer our brothers the following advice:
1 – They should urge the khateebs of the mosques to tell the people and warn them. They should explain this matter to the imaam of the mosque and tell him when this day is approaching. They should give him a copy of the fatwas of the Standing Committee and of Shaykh Muhamamd ibn Saalih ibn ‘Uthaymeen (may Allah forgive him). Every person should make the effort to contact the imaam of his mosque and tell him about this. Certainly, there are imaams of mosques among the brothers so perhaps the responsibility of telling them about this will be discharged when they read this article.
2 – Every teacher should explain the reality of this holiday and warn his or her students about it. They will be answerable before Allah tomorrow. They should explain that it is haraam by quoting the Fatwaa of the Standing Committee. All that should begin a week beforehand in order to be of any benefit.
3 – Those who go around and check on people and the headquarters of organizations should be notified of any shops which are selling gifts for this day or which put up pictures showing what the gift is or how it is wrapped.
4 – Each person should make his family members aware of this. Whoever has sisters in school or brothers should tell them and warn them about this matter, because many people are unaware of this holiday and what it means.
We ask Allah to protect the Muslims from the harm of temptations and from the evil of their own selves and the plots of their enemies, for He is the All-hearing Who answers prayers. May Allah send blessings upon His slave and Messenger Muhammad, and upon all his family and companions.