Rho(D) immune globulin: Difference between revisions
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==General== | ==General== | ||
*Type: | *Type: Immune Globulin | ||
*Routes of Administration: IM, IV | |||
*Routes of Administration: | *Common Trade Names: RhoGAM, WinRho | ||
*Common Trade Names: | |||
==Adult Dosing== | ==Adult Dosing== | ||
===[[Vaginal bleeding in pregnancy (less than 20wks)|1st Trimester (< | ===[[Vaginal bleeding in pregnancy (less than 20wks)|1st Trimester (<12weeks) Vaginal Bleeding]]=== | ||
*50 microgm IM | *Abortion or pregnancy loss (managed medically or surgically), ACOG now recommends '''no''' routine Rh testing or Rho(D) immune globulin prophylaxis.<ref>ACOG Clinical Practice Update: Rh D Immune Globulin Administration After Abortion or Pregnancy Loss at Less Than 12 Weeks of Gestation. Obstet Gynecol. 2024 Dec 1;144(6):e140-e143. doi: 10.1097/AOG.0000000000005733. Epub 2024 Sep 10. PMID: 39255498.</ref> | ||
**There is no harm in giving the standard 300 microgram dose, which is more readily available | *Exceptions may include [[Trauma in pregnancy|trauma]] and [[ectopic]] (because the dataset does not include that population and the amount of fetomaternal hemorrhage and risk of alloimmunization is unknown) | ||
**Dose is 50 microgm IM<ref>RhD alloimmunization: Prevention in pregnant and postpartum patients. Uptodate. Accessed 2/4/21</ref> | |||
***There is no harm in giving the standard 300 microgram dose, which is more readily available | |||
===[[Vaginal bleeding in pregnancy (greater than 20wks)|2nd & 3rd Trimester Vaginal Bleeding]]=== | ===[[Vaginal bleeding in pregnancy (greater than 20wks)|2nd & 3rd Trimester Vaginal Bleeding]]=== | ||
*300 microgm IM once and send Kleihauer-Betke test | *300 microgm IM once and send Kleihauer-Betke test | ||
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==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Same as adult dosing above | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*[[Lactation risk categories|Lactation risk]]: | **Animal studies have not been conducted, though available evidence suggest that administration of RhIG during pregnancy does not harm fetus<ref>ACOG practice bulletin. Prevention of Rh D alloimmunization. Number 4, May 1999 (replaces educational bulletin Number 147, October 1990). Clinical management guidelines for obstetrician-gynecologists. American College of Obstetrics and Gynecology. Int J Gynaecol Obstet. 1999; 66(1):63-70. [PubMed 10458556]</ref> | ||
*[[Lactation risk categories|Lactation risk]]: | |||
**Caution advised while breastfeeding, however no adverse events observed | |||
*Renal Dosing | *Renal Dosing | ||
** | **No dosage adjustments | ||
*Hepatic Dosing | *Hepatic Dosing | ||
** | **No dosage adjustments | ||
==Indications== | ==Indications== | ||
*For fetal maternal hemorrhage | *For <b> risk</b> of fetal maternal hemorrhage, such as blunt abdominal trauma | ||
*Risk = >4-12wks | *Risk = >4-12wks | ||
*Duration effect: 12wks | |||
*Also given to Rh- male trauma patients who receive O+ blood to prevent future reaction with O+ transfusions<ref>Miraflor, E, et al. Emergency uncrossmatched transfusion effect on blood type alloantibodies. J Trauma. 2012; 72:48-53.</ref> | *Also given to Rh- male trauma patients who receive O+ blood to prevent future reaction with O+ transfusions<ref>Miraflor, E, et al. Emergency uncrossmatched transfusion effect on blood type alloantibodies. J Trauma. 2012; 72:48-53.</ref> | ||
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==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*[[Anaphylaxis]] | |||
*Viral transmission risk | |||
*Acute intravascular hemolysis in patients with [[ITP]] | |||
*[[Acute transfusion reaction]] | |||
===Common=== | ===Common=== | ||
*Fever | |||
*Injection site reaction | |||
*Headache | |||
*Myalgias | |||
*Fatigue | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: Approximately 30 days | ||
*Metabolism: | *Metabolism: Unknown | ||
*Excretion: | *Excretion: Unknown | ||
*Mechanism of Action: | *Mechanism of Action: | ||
**Exact mechanism unknown | |||
**Prevents isoimmunization by suppressing immune response by Rh negative individuals against Rh positive blood cells | |||
==Comments== | ==Comments== | ||
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==See Also== | ==See Also== | ||
*[[Vaginal Bleeding (Main)]] | *[[Vaginal Bleeding (Main)]] | ||
==External Links== | |||
*https://www.fda.gov/media/75013/download | |||
==References== | ==References== | ||
Latest revision as of 15:50, 16 April 2025
General
- Type: Immune Globulin
- Routes of Administration: IM, IV
- Common Trade Names: RhoGAM, WinRho
Adult Dosing
1st Trimester (<12weeks) Vaginal Bleeding
- Abortion or pregnancy loss (managed medically or surgically), ACOG now recommends no routine Rh testing or Rho(D) immune globulin prophylaxis.[1]
- Exceptions may include trauma and ectopic (because the dataset does not include that population and the amount of fetomaternal hemorrhage and risk of alloimmunization is unknown)
- Dose is 50 microgm IM[2]
- There is no harm in giving the standard 300 microgram dose, which is more readily available
- Dose is 50 microgm IM[2]
2nd & 3rd Trimester Vaginal Bleeding
- 300 microgm IM once and send Kleihauer-Betke test
- Within 72hrs give additional 300 microgm/15 ml Rh-positive blood
Pediatric Dosing
- Same as adult dosing above
Special Populations
- Pregnancy Rating: C
- Animal studies have not been conducted, though available evidence suggest that administration of RhIG during pregnancy does not harm fetus[3]
- Lactation risk:
- Caution advised while breastfeeding, however no adverse events observed
- Renal Dosing
- No dosage adjustments
- Hepatic Dosing
- No dosage adjustments
Indications
- For risk of fetal maternal hemorrhage, such as blunt abdominal trauma
- Risk = >4-12wks
- Duration effect: 12wks
- Also given to Rh- male trauma patients who receive O+ blood to prevent future reaction with O+ transfusions[4]
Contraindications
- Allergy to class/drug
- Prior sensitization of mother
- Known Rh-negative father
- Known Rh-negative fetus (from cord blood)
Adverse Reactions
Serious
- Anaphylaxis
- Viral transmission risk
- Acute intravascular hemolysis in patients with ITP
- Acute transfusion reaction
Common
- Fever
- Injection site reaction
- Headache
- Myalgias
- Fatigue
Pharmacology
- Half-life: Approximately 30 days
- Metabolism: Unknown
- Excretion: Unknown
- Mechanism of Action:
- Exact mechanism unknown
- Prevents isoimmunization by suppressing immune response by Rh negative individuals against Rh positive blood cells
Comments
See Also
External Links
References
- ↑ ACOG Clinical Practice Update: Rh D Immune Globulin Administration After Abortion or Pregnancy Loss at Less Than 12 Weeks of Gestation. Obstet Gynecol. 2024 Dec 1;144(6):e140-e143. doi: 10.1097/AOG.0000000000005733. Epub 2024 Sep 10. PMID: 39255498.
- ↑ RhD alloimmunization: Prevention in pregnant and postpartum patients. Uptodate. Accessed 2/4/21
- ↑ ACOG practice bulletin. Prevention of Rh D alloimmunization. Number 4, May 1999 (replaces educational bulletin Number 147, October 1990). Clinical management guidelines for obstetrician-gynecologists. American College of Obstetrics and Gynecology. Int J Gynaecol Obstet. 1999; 66(1):63-70. [PubMed 10458556]
- ↑ Miraflor, E, et al. Emergency uncrossmatched transfusion effect on blood type alloantibodies. J Trauma. 2012; 72:48-53.