RhoGAM®

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RhoGAM

• Updates and Clarifications

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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)

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Procedure continued

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

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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

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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

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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

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