pharmachologic effect
Human anti-rhesus immunoglobulin RhO(D) is a protein fraction with immunological activity. It is isolated from the serum or plasma of those donors who were initially tested for the absence of antibodies to HIV , hepatitis C in the blood, and the surface antigen of the hepatitis B virus was also absent in the blood. The active ingredient of the drug is immunoglobulin G, which contains incomplete anti-Rho ( D) antibodies. Under the influence of this drug in the body of a pregnant woman with negative Rh, who has given birth to children with positive Rho (D), or who has undergone an abortion if the man's blood is Rho (D) positive, Rh sensitization is prevented (that is, the formation of Rho (D) antibodies).
Anti-Rhesus immunoglobulin
You can buy the drug in Moscow with a doctor's prescription. Human anti-Rhesus immunoglobulin is an immunologically active protein fraction isolated from human plasma or serum of donors tested for the absence of antibodies to the human immunoglobulin virus, hepatitis C virus and hepatitis B virus surface antigen. The active component of the drug is immunoglobulin G, which contains incomplete anti-Rhesus antibodies.
It prevents isoimmunization of an Rh-negative mother exposed to Rh-positive fetal blood in the following cases:
- At the birth of a Rh-positive child;
- In case of spontaneous or artificial abortion;
- In case of amniocentesis (sampling of amniotic fluid for analysis);
- If you receive an injury to the abdominal organs during pregnancy.
Immunoglobulin during pregnancy reduces the incidence of maternal Rh isoimmunization when administered within 48–72 hours after the birth of a fully term Rh-positive child by an Rh-negative mother. Anti-Rhesus immunoglobulin (price in Russia varies from 5800 to 6200 rubles) is used to prevent Rh-conflict in Rh-negative women who have not developed Rh antibodies during their first pregnancy, who gave birth to an Rh-positive child, whose blood is compatible with the mother’s blood according to blood groups AVO systems. Gamma immunoglobulin is also administered during artificial termination of pregnancy in Rh-negative women who are not sensitized to the Rh antigen, if the husband has Rh-positive blood. Specific immunoglobulin is not administered in cases of hypersensitivity to the drug, in Rh-negative postpartum women, sensitized to the Rh antigen, in whose blood serum Rh antibodies are detected, and in newborns.
Indications for use
This product can only be used as directed by a specialist. The drug is indicated for use to ensure the prevention of Rh conflict in women who have a negative Rh factor in the following cases:
- during pregnancy and subsequent birth of a child with a positive Rh factor;
- in case of spontaneous or intentional termination of pregnancy ;
- in case of termination of an ectopic pregnancy ;
- if there is a threat of spontaneous abortion in any trimester;
- after amniocentesis , as well as other procedures in which there is a risk that fetal blood may be in the mother’s blood;
- in case of abdominal trauma.
KamROU (KamRho)
The drug is administered by intramuscular injection.
Before administration, ampoules with the drug are kept for 2 hours at room temperature (18-22 °C). To avoid foam formation, the drug is drawn into a syringe with a wide bore needle. The drug cannot be stored in an opened bottle. The drug is administered only intramuscularly, once: to a postpartum woman - during the first 48-72 hours after birth, in case of artificial termination of pregnancy - immediately after the end of the operation. One dose - 300 mcg at a titer of 1:2000 or 600 mcg at a titer of 1:1000. Cannot be administered intravenously. Human anti-rhesus immunoglobulin Rho (D) is administered in one dose of 300 mcg (1500 IU), sometimes two doses of 600 mcg (3000 IU) intramuscularly once: to a postpartum woman - within 72 hours after birth; in case of termination of pregnancy - immediately after the end of the operation.
The following criteria must be met:
1. The mother must be Rh negative and must not already be sensitized to Rho (D) factor.
2. Her child must be Rh positive.
If the drug is given before delivery, it is essential that the mother receives another dose of the drug after the birth of her Rh-positive baby within 72 hours of delivery. If it is determined that the father is Rh negative, there is no need to administer the drug.
Pregnancy and other conditions associated with pregnancy and childbirth:
1. For prophylaxis during the postpartum period, one dose of 300 mcg (1500 IU) of CamROU should be administered, preferably within 72 hours after birth. The need for a certain dose in the case of a full term pregnancy varies depending on the volume of fetal blood entering the mother's bloodstream. One dose of 300 mcg (1500 IU) contains a sufficient amount of antibodies to prevent sensitization to the Rh factor, if the volume of fetal red blood cells entering the mother's bloodstream does not exceed 15 ml. In cases where a larger volume of fetal red blood cells (more than 30 ml of whole blood or more than 15 ml of red blood cells) is expected to enter the maternal circulation, fetal red blood cells should be counted using an approved laboratory technique (for example, the modified Kleihauer and Vetka acid washout-stain method ) to establish the required dosage of immunoglobulin. The calculated volume of fetal red blood cells entering the mother's bloodstream is divided by 15 ml and the number of doses of CamROU that must be administered is obtained. If the calculated dose results in a fraction, round the number of doses up to the next whole number (for example, if the result is 1.4, administer 2 doses of 600 mcg (3000 IU)).
2. For prophylaxis in the prenatal period, at approximately the 28th week of pregnancy, one dose of the drug 300 mcg (1500 IU) is administered. This must be followed by another dose of 300 mcg (1500 IU), preferably within 48-72 hours after birth, if the newborn baby is Rh positive.
3. If pregnancy continues after the threat of abortion arises, at any stage of pregnancy it is recommended to administer one dose of the drug 300 mcg (1500 IU). If it is suspected that more than 15 ml of fetal red blood cells have entered the maternal bloodstream, the dose must be adjusted as described in point 1 above.
4. After spontaneous abortion, induced abortion or termination of ectopic pregnancy during pregnancy more than 13 weeks, it is recommended to administer one dose of the drug 300 mcg (1500 IU). If it is suspected that more than 15 ml of fetal red blood cells have entered the maternal circulation, the dose must be adjusted as described in point 1. If the pregnancy is terminated at less than 13 weeks, a single mini-dose of CamROU (approximately 50 mcg (250 IU)) may be used.
5. After amniocentesis, either at 15-18 weeks of pregnancy, or during the third trimester of pregnancy, or if abdominal trauma occurs during the second and/or third trimester, it is recommended to administer one dose of the drug 300 mcg (1500 IU). If it is suspected that more than 15 ml of red blood cells have entered the mother's bloodstream, the dose must be changed as described in point 1. If abdominal trauma, amniocentesis or other adverse circumstance requires administration of the drug at 13-18 weeks of pregnancy, another dose of the drug should be administered 300 mcg (1500 IU) at 26-28 weeks. To maintain protection throughout pregnancy, the concentration of passively obtained anti-Rho(D) antibodies should not fall below the level necessary to prevent an immune response to Rh-positive fetal red blood cells. The half-life of human anti-Rhesus immunoglobulin Rho (D) is 28-35 days. In any case, the dose of the drug should be administered within 48-72 hours after birth - if the child is Rh positive. If delivery occurs within 3 weeks of the last dose, the postpartum dose can be discontinued (unless more than 15 ml of fetal red blood cells have entered the maternal circulation).
Side effects
Adverse reactions are rare. When this drug is administered, the following manifestations are possible:
- hyperemia of the skin in the places where the solution is injected;
- on the first day after the injection - increased body temperature, dyspeptic symptoms;
- various allergic manifestations .
, anaphylactic shock may develop . Patients who have been administered the medicine must remain under the supervision of specialists for half an hour after the injection. The specialist should have the opportunity to carry out anti-shock treatment if necessary.
Instructions for Anti-Rhesus Immunoglobulin (Method and dosage)
Before administering the ampoule with the solution, it must be kept at a temperature of 18 to 22 °C for two hours. It cannot be administered intravenously. To prevent the formation of foam, you need to draw the solution into the syringe with a wide-bore needle. An opened bottle cannot be stored.
One dose of the drug is administered intramuscularly once. After childbirth, a woman is given Immunoglobulin during the first three days.
When terminating a pregnancy, the injection should be given immediately after the operation.
The need to administer a certain dose of the drug during a full pregnancy is determined depending on how much fetal blood enters the mother’s bloodstream.
For the purpose of prevention, one dose (300 mcg) of the drug is administered before childbirth; it should be administered at approximately 28 weeks of pregnancy. 2-3 days after birth, another dose of Immunoglobulin is administered, provided that the baby is Rh-positive.
If there is a threat of miscarriage during any period of gestation, one dose of the medicine should be administered.
If a spontaneous abortion or termination of an ectopic pregnancy after the 13th week of gestation, it is recommended to administer 1 dose of the drug. If pregnancy is terminated before the 13th week, a mini-dose (50 mcg) can be administered.
In other cases, the indications and dosage of the drug are determined exclusively by a specialist. It will also help determine which anti-Rhesus Immunoglobulin is better.
The use of anti-Rhesus immunoglobulin in different trimesters
Doctors prescribe anti-Rhesus immunoglobulin to pregnant women after receiving the results of an analysis for the presence of antibodies to the D-antigen. If sensitization has already begun, there is no point in administering the drug. In this case, specific therapy is carried out.
In the first trimester of pregnancy, the risk of mixing blood accompanies an abortion or an incipient miscarriage. After termination of pregnancy, the woman is given one dose of anti-Rhesus immunoglobulin. If the pregnancy has been maintained and the threat of miscarriage has passed, the pregnant woman is given a mini-dose of the drug (from 50 to 75 mcg). Subsequently, the presence of antibodies in the blood of the pregnant woman must be monitored.
If an abdominal injury occurs or an amniocentesis is performed during the second trimester, between 13 and 18 weeks, a hematoma or hemorrhage may cause preterm labor. In this case, the patient is given 1 dose of anti-Rhesus immunoglobulin. Repeated administration of the drug is carried out at 26-28 weeks of pregnancy. If a hematoma has developed, anti-Rhesus immunoglobulin is administered every 4 weeks until delivery.
A multiparous woman who did not have antibodies to the D-antigen before the third trimester and had no injuries; if the placenta is in a normal state, a prophylactic dose of anti-Rhesus immunoglobulin is administered at 28 weeks. The doctor individually assesses the degree of risk of Rh conflict and decides on the need to re-introduce the drug at a later date. In case of placental abruption, trauma, or the threat of premature birth, anti-Rhesus immunoglobulin must be re-administered. If there is no risk, a second injection of the drug is given after childbirth.
Anti-Rhesus Immunoglobulin during pregnancy and lactation
If indicated, the drug is administered to women during pregnancy , and also, if necessary, after childbirth . In this case, the instructions for pregnancy, which contain information about the dosage of the drug, must be strictly followed. Reviews from women indicate that the drug, as a rule, does not cause significant side effects. Whether it is possible to receive anti-Rhesus Immunoglobulin during pregnancy for free, you need to find out at a specific medical institution.
