1. Updates and Clarifications
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. Sheila Mangiaracina, RN July, 2004
Authors
Kathy Lemenu, RN
Sheila Mangiaracina, RN
July, 2004
Please comments, questions to either Kathy or Sheila.