®
RhoGAM
Updates and Clarifications
®
RhoGAM
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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)
Mechanism of Action
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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
Use in Obstetrics
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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
Obstetrical procedures
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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
Use after Rh Incompatible
Transfusion
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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
Precautions
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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
More precautions
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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
Antepartum Procedure
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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
“What if my patient received RhoGAM®
within 3 weeks prior to delivery?”
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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
Procedure to follow with
Rh-negative mother
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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
Procedure continued
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Baby is Rh-negative,
inform mom and do
nothing else
Procedure continued
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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
Rh sensitized patients
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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
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
Authors
Kathy Lemenu, RN
Sheila Mangiaracina, RN
July, 2004
Please email comments, questions to either Kathy or Sheila.