Rho(D) immune globulin (Gamulin Rh, HypRho-D MICRhoGAM, MiniGamulin Rh, Rhesonativ, RhoGAM, WinRho)
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Indications
- prevent alloimmunization in Rh-negative women exposed to Rh+ blood
- during delevery of an Rh+ infant
- as a result of abortion
- following amniocentesis or abdominal trauma
- following a transfusion accident
- Rh isoimmunization
- to prevent hemolytic disease of the newborn if there is a subsequent pregnancy with an Rh+ fetus
- treatment of refractory immune thrombocytopenic purpura (ITP)
Contraindications
- Rho(D)-positive patient
- hypersensitivity to immune globulins or thimerosal
- transfusion of Rho(D)+ blood in previous 3 months
- prior sensitization to Rho(D)
Caution:
Benefit/risk
- Rhogam at 28 & 24 weeks of gestation in at risk women
- unclear benefit[3]
- Rhogam postpartum in at risk women
- number needed to treat = 8 to prevent alloimmunization in a future pregnancy[3]
Dosage
- 1 vial (300 ug) IM prevents maternal sensitization of fetal RBC volume that has entered maternal circulation is < 15 mL
- if more, give additional vials
- number of vials = RBC volume (mL) of fetomaternal hemorrhage divided by 15
Antepartum prophylaxis:
- 1 vial (300 ug) IM at 26-28 weeks of gestation
- followed by another vial (300 ug) IM within 72 hours of delivery if fetus is Rh+
Following miscarriage, abortion, or termination of ectopic pregnancy:
- up to 13 weeks of gestation:
- 50 ug IM within 3 hours, but may be given up to 72 hours later
- after 13 week of gestation: 300 ug IM
Injection:
Pharmacokinetics
elimination: liver
Adverse effects
- most common (1-10%)
- rare[2]
- severe & sometimes fatal, intravascular hemolysis
- disseminated intravascular coagulation in patients with ITP
Notes
- Acetaminophen may ease minor discomfort after vaccination.
More general terms
Additional terms
References
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 2.0 2.1 FDA Medwatch http://www.fda.gov/medwatch/safety/2006/safety06.htm#WinRho
- ↑ 3.0 3.1 3.2 The NNT: Anti-D (Rh Factor) Administration During Late Pregnancy for the Prevention of Alloimmunization in At-Risk Women. http://www.thennt.com/nnt/rhogam-in-late-pregnancy-for-prevention-of-sensitization-in-at-risk-women/
The NNT: Anti-D (Rh Factor) Immunoglobulin Administration Postpartum for the Prevention of Alloimmunization in At-Risk Women. http://www.thennt.com/nnt/rhogam-postpartum-for-prevention-of-sensitization-in-at-risk-women/
Crowther C, Middleton P. Anti-D administration after childbirth for preventing Rhesus alloimmunisation. Cochrane Database Syst Rev. 2000;(2):CD000021. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10796089