Rh o (D) immune globulin ( Rhig ) is a drug used to prevent Rh isoimmunization in Rh-negative mothers and treat idiopathic purpura thrombocytopenics ( ITP) in people who are Rh positive. Often given both during and after pregnancy. It can also be used when Rh negative people are given Rh positive. This is given by injection into muscles or veins. Single dose lasts 2 to 4 weeks.
Common side effects include fever, headache, injection at the injection site, and damage to red blood cells. Other side effects include allergic reactions, kidney problems, and the risk of a very small viral infection. In those with ITP the amount of red blood cell damage may be significant. Use safe with breastfeeding. Rho (D) immune globulin consists of antibodies against the Rh o (D) antigen present in some red blood cells. It is believed to work by blocking one's immune system from recognizing this antigen.
Rh o (D) immune globulin began to be used in the 1960s. It's in the List of Essential Medicines of the World Health Organization, the most effective and safe drugs needed in the health system. In the United Kingdom, a 1500 unit (300 mcg) costs the NHS about 58 pounds. In the United States, medical expenses are over 200 USD. It's made from human blood plasma.
Video Rho(D) immune globulin
Medical use
In pregnancy where the mother is Rho (D) -negative and the father is Rho (D) -positive, the possibility of the fetus having Rho (D) -positive blood depends on whether the father is homozygous for Rho (D) -positive (either Rho (D) positive alleles) or heterozygotes (one Rho (D) positive allele and the other negative). If the father is homozygous, the fetus will always be Rho (D) -positive, since the father will always forward to the Rho (D) -positive allele. If the father is heterozygous, there is a 50% chance that the fetus will be Rho (D) -positive, since it will randomly forward either the Rho (D) -positive allele or the Rho (D) -negative allele. If the fetus is Rho (D) -positive and the mother is Rho (D) -negative, the mother is at risk Rho (D) alloimmunization, in which the immune response's immune mother (develops antibodies) into the fetal red blood cells. This usually has a minimal effect on the first pregnancy, but in such a second pregnancy, maternal antibodies already present to Rho (D) antigens in fetal red blood cells often lead to fetal erythroblastosis, a condition that can be fatal to the fetus. In countries without the Rhig protocol, as many as 14% of affected fetuses are stillborn and 50% of live births cause neonatal or brain injury.
Because of this severe complication, the American College of Obstetricians and Gynecologists (ACOG) recommends that all Rho (D) -negative mothers, regardless of fetal blood type, receive Rhig at about 28 weeks of pregnancy, and again immediately after delivery. This should be given within 3 days of potential exposure to Rh-positive blood from infants as is possible during miscarriage, trauma, or labor. The '28 week 'recommendation stems from the fact that 92% of women who develop anti-D during pregnancy do so at or after 28 weeks of pregnancy. This is given with intramuscular injection as part of modern routine antenatal care. Despite the excellent results, these drugs retain the FDA Pregnancy Category C.
Rhig is recommended in the UK after an antenatal pathological event that tends to cause fetal-maternal bleeding. Applicable 'pathological events' include accidents that may induce fetomaternal bleeding (motor vehicle accidents, falls, abdominal trauma), following obstetric/gynecological procedures during pregnancy, and at times of threatened or spontaneous/elective abortion, regardless of gestational age.
There is no sufficient evidence that the use of Rho immunoglobulin (D) after spontaneous abortion is required and Cochrane's review recommends that local practices should be followed.
In Rhesus-negative mother, immune globulin (D) immune globulin may prevent temporary sensitization of the maternal immune system to Rh D antigen, which may cause rhesus disease at this time or in subsequent pregnancies. With the widespread use of Rho immunoglobulin (D), Rh disease in the fetus and newborn almost disappears in developed countries. The risk that a D-negative mother can be alloimmunized by a positive D-fetus can be reduced from about 16% to less than 0.1% by the appropriate Rhig administration.
Rho (D) immune globulin is composed of IgG antibodies and is therefore capable of crossing the placenta. In rare cases this can cause the baby to have a weak positive DAT (direct antiglobulin test) because of the sensitization of fetal cells from mothers who have received some doses of Rho (D) immune globulin. However, no treatment is needed because the clinical direction is benign.
The following delivery
A D-negative mother who is not alloimmunized to D should also receive the exact dose of Rhig after giving birth to a D-positive baby. After delivery, cord blood samples from infants born to D-negative mothers should be tested for antigen D. If the neonate is D-negative, no further stimulation is required. However, if the infant is positive, the mother should have a postpartum blood sample examined for fetomaternal haemorrhage to determine the exact dose of RhIG to be administered. (the presence of anti-D residues from the antepartum RhIG administration does NOT indicate the continuous protection of Rhomb alloimmunization re- quirements required).
A rosette test is a sensitive method for detecting fetomaternal bleeding 10 cc or more. The rosette test will be positive if the fetal D-positive cells present in the mother sample, indicating significant fetomaternal bleeding have occurred. A rosette test may be false positively if the mother is positive for a weak and false negative phenotype D if the neonate is weak D. If the rosette test is negative, then it is given 300 micrograms of RhIG (enough to prevent allounization after delivery in 99% of cases). Rhym dose suppresses the immune response to 30 cc of intact fetal blood.
If fetomaternal bleeding more than 30 cc has occurred, additional testing is mandatory to determine the exact dose of RhIG to prevent alloimmunization. A positive rosette test should be followed by a quantitative test such as the Kleihauer-Betke (acid/elution) test or alternative approaches such as flow cytometry. See the article on the Kleihauer-Betke test for details on how the volume of fetomaternal hemorrhage is calculated.
Rhym dose is calculated from the volume of fetal hemorrhage (in mL). Example: 50 mL fetal hemorrhage/30 ml = 1.667 (rounded to 2) then add 1 = 3 bottles of RhIG.
Postpartum Rhig should be given within 72 hours after delivery. If prophylaxis is delayed, the possibility of alloimmunization will be prevented from decreasing. However, ACOG still recommends that RhIG be managed because partial protection still occurs. If the D-type of a newborn or stillbirth is unknown or undetermined, RhIG must be administered.
Immune thrombocytopenia
Primary immune thrombocytopenia (ITP) is an immune-mediated disorder characterized by isolated thrombocytopenia, defined as the number of peripheral blood platelets less than 100 x 10 9 /L, and the absence of clear initiation and/or the underlying cause of thrombocytopenia. Symptoms of ITP include abnormal bleeding and bruising due to a decrease in platelet count. Rh o (D) Immune Intravenous Globulin [Human; Anti-D] is indicated for use in non-splenectomized Rh o (D) children, with children with chronic or acute ITP, adults with chronic ITP, and children and adults with ITP due to HIV infection. Anti-D should be given via an intravenous route when used in clinical situations that require an increase in platelet count. The anti-D action mechanism is not fully understood; However, after administration of a complex of red-blooded anti-D saturated Fc cells? receptor sites in macrophages, resulting in the destruction of red blood cells (red blood cells) that are special, thus leaving platelet-coated antibodies. Anti-D is recommended as first-line therapy for ITP, along with corticosteroids and intravenous immunoglobulin (IVIG). WinRho SDF is an anti-D that is manufactured, distributed and marketed by Cangene Corporation in the US.
Maps Rho(D) immune globulin
Contraindications
The following women are NOT candidates for Rhig:
- D-negative female whose fetus is known as D-negative
- D-negative women who have previously been allergic to D (they have anti-D antibodies)
- Every D-positive woman (female tested positive for weak D phenotype should be considered D-positive and not accept Rhig).
History
The first "skymed" Rho immunoglobulin (D) immunoglobulin treatment was introduced by Ortho-Clinical Diagnostics, a subsidiary of Jskymed, and was first given May 29, 1968 to Marianne Cummins in Teaneck, NJ.
In 1996 ZLB Bioplasma (part of CSL Behring) was granted approval to sell Rhophylac in Europe. Effectiveness was demonstrated in clinical trials in 2003 and in 2004 Rhophylac was approved in the United States.
Society and culture
Manufacturing and security
Rho (D) immune globulin is a derivative of human plasma. The most common anti-D product produced is by the form of cold Cohn ethanol fractionation method developed in the 1950s. The variety of Cohn methods developed in the 1950s may not fully explain the aggregate immunoglobulin, which can cause problems for patients if given intravenously, and is the main reason why most anti-D is only for intramuscular use. The non-Cohn manufacturing variety is the ChromaPlus process approved by the US Food and Drug Administration (FDA) used to make Rhophylac. Rho (D) immune globulin can trigger an allergic reaction. Steps taken in the plasma-donor screening process and manufacturing process to remove bacterial and viral contamination, although small, remainder of the risk may remain for contamination with small viruses. There is also a theoretical possibility of a prion transmission responsible for Creutzfeldt-Jakob disease, or another, an unknown infection agent.
Administrative route
RhIG may be administered by intramuscular (IM) or intravenous (IV) injection, depending on preparation. IM-only preparation should not be given IV because of the risk of complementary system activation. Some IM doses should be given at different sites or at different times within 72 hours. Alternatively, some IV doses may be given in accordance with the instructions on the packaging inserts.
Name
Rh o (D) immune globulin also spells Rh 0 (D) immune globulin (o and zero digits both are widely proven; nomenklatur.
Rhophylac is produced by CSL Limited. RhoGAM and MICRhoGam are the brand names Kedrion Biopharma. Other brand names are BayRHo-D, Gamulin Rh, HypRho-D Mini-Dose, Mini-Gamulin Rh, Partobulin SDF (Baxter), Rhesonativ (Octapharma), and RhesuGam (NBI). KamRho-D I.M. is the brand name of Kamada Ltd.
US distribution rights to WinRho SDF (another brand name) were transferred from Baxter to manufacturer, Cangene, in 2010; they have been held by Baxter since 2005. WinRho's sales fall every year under an agreement with Baxter, assuming that Baxter supports the sale of its own products rather than WinRho; according to an analyst, "WinRho has always been an afterthought for big companies like Baxter."
See also
- The hemp blood type system
- Blood type
- Immunology
- Rh disease
- James Harrison (blood donor) (Mr. Harrison's blood is used in the research process when this drug is made.)
References
External links
- Rhogam Product Website
- Product information
- Rho (D) Immune Globulin at US National Library of Medicine's Medical Subject Headings (MeSH)
Source of the article : Wikipedia
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