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RhoGAM ®

RhoGAM ®. Updates and Clarifications. RhoGAM ® description. Contains IgG anti-D (anti-Rh o ) Prevents Rh alloimmunization Manufactured from human plasma that contains anti-D

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RhoGAM ®

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  1. RhoGAM® Updates and Clarifications

  2. RhoGAM®description • Contains IgG anti-D (anti-Rho) • Prevents Rh alloimmunization • Manufactured from human plasma that contains anti-D • A single 300mcg dose will suppress the immune response to 15 ml of Rh-positive RBCs (approx 30 mL whole blood)

  3. Mechanism of Action • Suppresses the immune response of Rh-negative individuals to Rh-positive RBC’s • How it does this is not known • Is not effective once Rh alloimmunization has occurred

  4. Use in Obstetrics • Rh-negative pregnant patient may be exposed to RBC’s from her Rh-positive fetus • Can happen during the normal course of pregnancy or • After procedures or abdominal trauma • Given at 28 weeks • And within 72 hrs. of delivery

  5. Obstetrical procedures • Pregnancy/delivery of Rh-positive fetus irrespective of ABO groups of either mom or baby • Abortion/threatened abortion at any point in pregnancy • Ectopic pregnancy • Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, versions or abdominal trauma

  6. Use after Rh Incompatible Transfusion • Individuals transfused with Rh-positive RBC’s have an 80% likelihood of producing anti-D • This may occur when there are not enough Rh-negative platelets available and Rh-positive units are used • Rh alloimmunization can occur after exposure to <0.1 ml of Rh-positive blood • RhoGAM®should be administered within 72 hrs. of this exposure

  7. Precautions • For I.M. use only • Observe patient for 20 minutes after injection • Allergic responses may occur (extremely rare) • Inform patient to report early signs of hypersensitivity, hives, generalized urticaria, tightness of the chest, wheezing, hypotension and anaphylaxis • Treatment depends on severity of reaction

  8. More precautions • Never give RhoGAM® to baby • Some babies born of women given RhoGAM® have weakly positive direct antiglobulin (Coombs) tests at birth • Fetal-maternal hemorrhage may cause false blood typing results in mom • When there is any doubt as to pt.’s blood type, RhoGAM® should be administered

  9. Antepartum Procedure • In addition to the 28 week prophylactic dose • Patients may receive additional doses prior to delivery • If they have had a bleed, trauma, procedure etc., they will be given RhoGAM® • If RhoGAM® is administered for any indication in early pregnancy, there is an obligation to maintain levels of passively acquired anti-D by giving RhoGAM® at 12-week intervals • The anti-D will be present in the blood for a few weeks after administration and may show a positive ABS • This is the passive anti-Rh antibody and does not disqualify pt. from receiving additional injections of RhoGAM® as prescribed by HCP

  10. “What if my patient received RhoGAM® within 3 weeks prior to delivery?” • You will still send the mom’s blood to lab after delivery • PP dose may be withheld after a negative test for FMH (fetal maternal hemorrhage) • FMH test determines if exposure to > 15 mL of fetal RBC’s has occurred • Additional doses of RhoGAM® will be required if an FMH exceeds 15 mL • This event is unlikely to occur prior to the third trimester and is most likely to happen after birth

  11. Procedure to follow with Rh-negative mother • Determine mom is a RhoGAM® candidate • Fill out fluorescent red sticker entitled “RhoGAM® Candidate” and place on yellow In pt. progress notes • Send cord blood to lab with Blood Bank requisition all stamped with BABY’s name • Mark on requisition: √ Rh Immune Globulin Evaluation (under Infant studies box) Blood Bank will call to notify nurse of baby’s blood type

  12. Procedure continued • Baby is Rh-negative, inform mom and do nothing else

  13. Procedure continued • Baby is Rh-positive √ Verify mother is willing to receive RhoGAM® (it is a blood product) √ Collect blood from mom in pink top tube √ Send blood with BB requisition with Rh Immune Globulin (IM 300 mcg) checked stamped with Mom’s information √ BB will call when RhoGAM® is ready for patient √ BB will send the correct amount of RhoGAM® to be given √ Rarely will this amount be more than one injection √ RhoGAM® needs to be given within 30 minutes of arriving on unit √ Fill out Patient Identification Card and give to patient

  14. Rh sensitized patients • Patient’s who are already sensitized will not receive RhoGAM®. They are already producing the antibodies. • The antibodies she is now producing will destroy any Rh-positive cells that are present

  15. Last Words • Filling out RhoGAM® Control Form • The form is self explanatory • Both the lot number and the bar coded vial number should be recorded on the Form • If you have problems with it, see me or a preceptor for answers

  16. Authors Kathy Lemenu, RN Sheila Mangiaracina, RN July, 2004 Please email comments, questions to either Kathy or Sheila.

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