Rho(D) immune globulin: Nursing pharmacology

Notes

RhO (D) IMMUNE GLOBULIN
DRUG NAME
RhO (D) immune globulin (WinRho SDF, Rhophylac, HyperRHO S/D, MICRhoGAM, RhoGAM)
CLASS
Immune globulin
MECHANISM OF ACTION
Suppresses the mother’s immune response and antibody formation against the fetal Rh positive blood cells
INDICATIONS
Rh-negative pregnancy
ROUTE(S) OF ADMINISTRATION
IM
SIDE EFFECTS
  • Headache, drowsiness, and dizziness
  • Vasodilation, hypotension, hypertension
  • Injection site reaction: erythema, mild pain, discomfort
  • Drowsiness, pallor, fever
  • Asthenia or weakness
  • Diaphoresis or excessive sweating
CONTRAINDICATIONS AND CAUTIONS
  • Previous severe hypersensitivity reactions to immune globulins
  • IgA deficiency
  • Rh-positive clients
RhO (D) IMMUNE GLOBULIN: NURSING CONSIDERATIONS
GENERAL
  • Review the chart and ensure there are no contraindications
  • Confirm both the maternal and newborn’s blood type, and the maternal sensitization status
  • Blood product: ensure informed consent
  • Administer at 26–28 weeks gestation or within 72 hours of delivery, abortion, miscarriage or other obstetrical event such as invasive testing, placental abruption, abdominal trauma
  • Match lot number and expiration date
  • Administer IM in the deltoid or anterolateral thigh
MONITORING
  • For side effects: fever, injection site soreness or irritation, dizziness, or headache
  • For hypersensitivity reaction: wheezing, rash, angioedema, hypotension, or tachycardia
    • Call for help and notify physician
CLIENT EDUCATION
  • Why RhIG is needed
  • Potential side effects
  • Do not receive live vaccine within three weeks
  • Future pregnancies will be evaluated for the need for RhO (D) immune globulin administration
Author: Filip Vasiljević, MD
Author: Nancy Hutnik, RN
Illustrator: Robyn Hughes, MScBMC

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Content Reviewers

Antonella Melani, MD,Lisa Miklush, PhD, RNC, CNS,Gabrielle Proper, RN, BScN, MN,Jannah Amiel, MS, BSN, RN,Jodi Berndt, PhD, RN, CCRN-K, PCCN-K, CNE, CHSE,Kelsey LaFayette, DNP, ARNP, FNP-C

RhO (D) immune globulin, or RhIG for short, is a biological class of medications primarily used in the management of Rh-negative pregnancies, which occur when the client has Rh-negative blood, while the fetus has Rh-positive blood.

The first Rh-negative pregnancy is usually not associated with complications, but in the following pregnancies, this Rh incompatibility can cause severe, life-threatening fetal complications.

What happens is that during delivery of the first Rh-negative pregnancy, some of the baby’s red blood cells can get into the client’s circulation.

Now, since the mother has Rh-negative red blood cells, her immune system recognizes the baby’s Rh-positive red blood cells as foreign, and triggers the production of anti-Rh antibodies.

At first, the mother produces IgM antibodies, which are too big to cross the placenta, therefore there are no complications during the first pregnancy.

But, over time, the mother develops IgG anti-Rh antibodies, which are smaller. As a result, if another Rh-negative pregnancy occurs, these preformed IgG antibodies are able to cross the placenta and destroy the fetal Rh-positive red blood cells.

This process is called Rh isoimmunization, and ultimately causes hemolytic disease of the fetus and newborn, or HDFN for short.

In order to prevent Rh isoimmunization, all pregnant clients with Rh-negative blood should be given RhO (D) immune globulin, which can be administered intramuscularly.

Once RhO (D) immune globulin is administered, it suppresses the mother’s immune response and antibody formation against the fetus.

In fact, if the mother receives RhO (D) immune globulin within 72 hours postpartum, the chances of Rh isoimmunization drop to 1 or 2%.

Moreover, if the mother receives RhO (D) immune globulin at 28 weeks of gestation, and then again within 72 hours after the delivery, the chance of developing Rh isoimmunization becomes less than 1%!

Unfortunately, RhO (D) immune globulin is not effective when a client has already developed a positive antibody titer to the Rh antigen.

Finally, it’s important to note that mixing of maternal and fetal blood can occur during some obstetric complications, such as abortion, ectopic pregnancy, and placental abruption; as well as with some invasive obstetric procedures, like amniocentesis.

These cases also require the administration of RhO immune globulin to prevent the possible formation of IgG anti-Rh antibodies.

Now, the most common side effects associated with RhO (D) immune globulin administration include headache, drowsiness, and dizziness, as well as vasodilation, hypotension, or hypertension.

Additionally, clients might develop reactions at the injection site such as erythema, mild pain and discomfort.

Key Takeaways

RhO (D) immune globulin, also known as RhoGAM, is a medication that is most often used to prevent Rh isoimmunization in pregnant and postpartum clients. Isoimmunization happens when a pregnant individual with Rh-negative blood is exposed to Rh-positive fetal blood, resulting in the development of antibodies that can attack Rh-positive fetal blood cells. This can lead to hemolytic disease of the fetus and newborn or HDFN, with future pregnancies being at higher risk. So, it's important to remember to administer RhoGAM when indicated to prevent isoimmunization.

Sources

  1. "Karch’s Focus on Nursing Pharmacology. 9th edition. ISBN: 978-1-975180-40-9" LWW (2023)
  2. "Pharmacology: A Patient-Centered Nursing Process Approach. 9th edition. ISBN: 978-0-323-39916-6 " Elsevier Canada (2020)
  3. "Mosby’s 2023 Nursing Drug Reference. 36th edition. ISBN: 978-0-323-93072-7" Mosby (2022)
  4. "Saunders Comprehensive Review for the NCLEX-RN. 9th Edition. ISBN: 978-0-323-79530-2" Saunders (2022)
  5. "Rhesus D factor (RhD) negative women's experiences with pregnancy: An interpretive description. 33(6):e511-e518" Women Birth (2020)
  6. "Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children. 15(7):e0235807" PLOS ONE (2020)