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RhoGAM®

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RhoGAM Updates and Clarifications RhoGAM description Contains IgG anti-D (anti-Rho) Prevents Rh alloimmunization Manufactured from human plasma that contains ... – PowerPoint PPT presentation

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Title: RhoGAM®


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 RBCs
  • 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
    RBCs 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 RBCs
    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
    lt0.1 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 moms 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 gt 15 mL of
    fetal RBCs 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 BABYs name
  • Mark on requisition
  • v Rh Immune Globulin Evaluation
  • (under Infant studies box)
  • ? Blood Bank will call to notify nurse of babys
    blood type

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

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

14
Rh sensitized patients
  • Patients 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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