Rho(D) immune globulin: Difference between revisions

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==Background==
==General==
*For fetal maternal hemorrhage
*Type: Immune Globulin
*Routes of Administration: IM, IV
*Common Trade Names: RhoGAM, WinRho
 
==Adult Dosing==
===[[Vaginal bleeding in pregnancy (less than 20wks)|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.<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>
*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]]===
*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==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
**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
**No dosage adjustments
*Hepatic Dosing
**No dosage adjustments
 
==Indications==
*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>
==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==


==Treatment==
==See Also==
#1st Trimester
*[[Vaginal Bleeding (Main)]]
##--> give 50 microgm
#2nd & 3rd Trimester
##--> give 300 microgm once and send Kleihauer-Betke test
##--> within 72hrs give additional 300 microgm/15 ml Rh-positive  blood


===Exceptions===
==External Links==
# prior sensitization of mother
*https://www.fda.gov/media/75013/download
# known  Rh-negative father
# known Rh-negative fetus (from cord blood)


[[Category:Drugs]]
==References==
[[Category:OB/GYN]]
<references/>
[[Category:Pharmacology]]
[[Category:OBGYN]]

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

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

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

  1. ↑ 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.
  2. ↑ RhD alloimmunization: Prevention in pregnant and postpartum patients. Uptodate. Accessed 2/4/21
  3. ↑ 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]
  4. ↑ Miraflor, E, et al. Emergency uncrossmatched transfusion effect on blood type alloantibodies. J Trauma. 2012; 72:48-53.
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