RhOD immune globulin products for prevention of alloimmunization during pregnancy

Abstract

Routine administration of RhIG to women at risk for Rh alloimmunization is clinically effective and has made HDFN a rare clinical event. The available RhIG products are not the same and should be carefully reviewed to ensure that they are administered safely.

Prevention of RhD Alloimmunization: A Comparison of Four National Guidelines

“…UpToDate.com). 23 The RANZCOG guidelines mention the use of Rhopylac for IV anti-D immune globulin when large fetomaternal hemorrhage occurs.…”

Is the management of Rh-Rh incompatibility with noninvasive fetal Rh genotypingfor targeted prophylaxis cost-effective in the Turkish population?

“…In 1978, one case of hepatitis C transmission was reported in Ireland with the use of contaminated Rh IG products (16). In the United States there is no reported case of transmission by these products (17). All blood products also have a risk of transmission of prion diseases.…”

Critical updates in the 7th edition of the American Society for Apheresis guidelines

“…10,[131][132][133][134][135][136][137] If performed, both RBCx procedure and RhIG administration should be completed within 72 h from Rh(D)-positive RBC exposure (deriving from RhIG usage during pregnancy). 138 However, the inherent risks of these therapies, e.g., acute intravascular hemolysis leading to renal failure, DIC, and other complications, should be balanced against the risk of alloimmunization, the likelihood/desire for future pregnancies, and/or the risk of HDFN. [138][139][140] Thus, RBCx is used to decrease the amount of circulating Rh(D)positive RBCs to levels where RhIG can be safely administered (W), which have not been well-established yet.…”

“…138 However, the inherent risks of these therapies, e.g., acute intravascular hemolysis leading to renal failure, DIC, and other complications, should be balanced against the risk of alloimmunization, the likelihood/desire for future pregnancies, and/or the risk of HDFN. [138][139][140] Thus, RBCx is used to decrease the amount of circulating Rh(D)positive RBCs to levels where RhIG can be safely administered (W), which have not been well-established yet. Hence, careful assessment of the patient's clinical status, including renal and hemostasis conditions, should be performed for each case.…”

“…Hence, therapies, such as Rh immunoglobulin (RhIG) and/or RBCx may be provided to remove such Rh(D)‐positive RBCs – this is typically done when the Rh(D)‐positive RBC content is >20% of the RBC volume based on the new ASFA guidelines, which were derived from successful case reports and small case series . If performed, both RBCx procedure and RhIG administration should be completed within 72 h from Rh(D)‐positive RBC exposure (deriving from RhIG usage during pregnancy) . However, the inherent risks of these therapies, e.g., acute intravascular hemolysis leading to renal failure, DIC, and other complications, should be balanced against the risk of alloimmunization, the likelihood/desire for future pregnancies, and/or the risk of HDFN .…”