Rhogam?

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Rhogam. 

What is Rhogam?

  • an immunoglobulin which suppresses Anti-D antibody formation in an Rh- mother with possible Rh+ infant. Rhogam decreases the risk of antibody formation from ~12% to ~1%

  • We'll refer to the brand name (Rhogam) as its shorter to type than repetitively typing anti-D immunoglobulin

What are we trying to accomplish?

  •  Prevention of maternal sensitization and Hemolytic Disease of the Fetus and Newborn (HDFN).

  • If an Rh- mother is exposed to fetal Rh D antigen she may develop antibodies which will cross the placenta in subsequent pregnancies attack fetal RBC's.

  • While there is a spectrum of HFDN, in its most severe case it can lead to hydrops fetalis and fetal death

What are the reccomendations regarding the administration of Rhogam?

  • They vary

  • ACEP:

    • administer 50mcg of Rhogam to all Rh- women experiencing first trimester loss of established pregnancy

    • level C recommendation to consider administering Rhogam in case of minor abdominal trauma

    • insufficient evidence to recommend for or against its use in treating threatened abortion or ectopic pregnancy

  • ACOG

    • All Rh- negative women receiving instrumentation for a miscarriage should receive Rhogam

    • Recommended for-

      • all cases of ectopic pregnancy 

      • Rh- women experiencing antenatal hemorrhage after 20 weeks of gestation

      • Rh- women who experience abdominal trauma

      • Rh- women who experience fetal demise in the 2nd or 3rd trimester

    • Although the risk of alloimmunization is low, the consequence can be significant and administration of Rh D immune globulin should be considered in cases of spontaneous first-trimester miscarriage, especially those that are later in the first trimester.

  • Cochrane Review

    • Interesting conclusion:

    • “There are insufficient data available to evaluate the practice of anti-D administration in an unsensitised Rh-negative mother after spontaneous miscarriage. Thus, until high-quality evidence becomes available, the practice of anti-D Immunoglobulin prophylaxis after spontaneous miscarriage for preventing Rh alloimmunization cannot be generalized and should be based on the standard practice guidelines of each country.”

  • Contrast the American reccomendations with those of the NICE Guidelines (United Kingdom)

    • Do not offer Rhogam to women who receive solely medical management for an ectopic pregnancy or miscarriage, have a threatened miscarriage, have a complete miscarriage, or have a pregnancy of unknown location

    • Offer Rhogam to all Rh- women who have a surgical procedure to manage an ectopic pregnancy or miscarriage

Are there any risks of administering Rhogam?

  • Typically not. 

  • Side effects include fever, headache, injection site pain, and RBC breakdown (minor)

  • There have also been cases of allergic reactions, AKI, and viral infection

  • RBC breakdown may be significant in those with ITP 

What is the cost of Rhogam

  • ~$200 for a treatment

In conclusion.

  • Recommendations vary

  • We currently are aggressive in how we administer Rhogam

  • However side effects are few and the cost is not prohibitively expensive

-Elly

See TamingtheSru.com for more

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