Readers' Questions Regarding Rh-immune Globulin
Thursday, December 20, 2007
Kenneth F. Trofatter, Jr., MD, PhD
• At Tue Dec 04, 01:43:00 PM 2007, Teri said…
I was 2 months along when I found out that I was pregnant. I went to the emergency room after my body rejected my baby (spontaneous miscarriage). They informed that I have Rh-negative blood. They gave me a shot that sounded like 'rogain' and told me it would prevent antibodies from attacking my baby in my next prgnancy. Is that what the shot is for? Will it affect me if my future baby's father is Rh-negative also?
• At Fri Dec 14, 12:50:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…
To Teri Dec 4: Sorry about your miscarriage. You received Rhogam which is Rh-immune globulin that contains antibodies to Rh-positive blood cells. That helps your body destroy any Rh-positive red blood cells that might have gotten into your blood stream from the pregnancy and helps prevent you from developing antibodies of your own (just as the doctors told you in the ER). If the baby's father is Rh-negative too, then the baby could not be Rh-positive and you did not need the Rhogam, but it will not hurt that you got it either, now or with future pregnancies. In your next pregnancy, tell your doctor that you would like to have the baby's father's blood type tested as well. If he is indeed Rh-negative, then you won't need any 'Rhogam shots' during or after the pregnancy. Just be sure you "know who the Daddy is!" Thanks for your question!
Dr T
• At Thu Dec 06, 05:49:00 PM 2007, HAYAT said…
Hi. I'm 31 weeks pregnant. Today I had the Rhogam shot because I am O-negative. I didn't know what it is. I did search on the net and found out that I should have had it at 28 weeks? I am so worried. Is it too late for this shot? My doctor did take my blood before giving me the shot to perform an antibody screen? She gave me the shot after taking my blood. Does that mean I didn't develop the antibodies against the Rh-D antigen? I'm so confused and so sad. Can you please explain to me and tell me if my baby is at risk? And why didn't they give me the shot at 28 weeks. I'm sorry for my english if I made mistakes.
My name is HAYAT
THANK YOU
• At Fri Dec 14, 12:55:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…
To Hayat Dec 6: See my explanation above to our first reader. The 'shot' is Rh-immune globulin that contains antibodies against Rh(D)-positive red blood cells. That way, if the baby is Rh-positive and any of its red blood cells get into your circulation, the antibodies will help to destroy those cells before you have a chance to make your own antibodies to them. If you do develop your own antibodies, that is called alloimmunization (or isoimmunization). We frequently refer to that as 'sensitization' as well.
If you had not developed any antibodies before you got the shot, then you can stop worrying. The shot will help protect you from becoming sensitized during the rest of your pregnancy. We generally recommend giving the shot at 28 weeks because very few women will become sensitized before that time and the Rh-antibodies usually hang around until about 40 weeks (full term). The shot does not have to be given right at 28 weeks! Some folks give it a little earlier, and some a little later. Women who have trauma, bleeding, or other invasive procedures (such as an amniocentesis) may receive several 'shots' during there pregnancies. One injection of 'Rhogam 300mcg' will neutralize about 30 cc of whole fetal blood. The important thing is that you did get it in time. You should be fine! After delivery, if your baby does turn out to be Rh-positive, your doctors may check your blood to see how much of the baby's blood got into your circulation and then adjust the amount of Rh-immune globulin to make sure you eliminate the fetal red blood cells. Good luck with the rest of your pregnancy and let us know how things turn out!
Dr T
Labels: rh-immune globulin, Rh-isoimmunization, Rh-negative blood type
19 Comments:
At Sun Dec 23, 05:11:00 PM 2007,
Gillian said…
I was told (at around 22 hours of labour) that I had isoimmunization, but no one has really explained what that means, or how I can cope with it in future pregnancies. My son is fine, but I was told that it's the future pregnancies that I have to worry about, but I can't seem to find any details on what this means.
Will I miscarry? Would the children I carry be born with defects? I can't find any information online about it either.
Any information you have would be very appreciated. (Oh, and I'm told that I'm NOT Rh-.)
At Fri Jan 04, 07:00:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
Hi Gillian: What that "means" depends on the type of isoimmunization you have developed. Why don't you try to find out which blood antigen you have become senistitized to and I will try to answer your questions regarding risks. But, to answer one question, isoimmunization rarely is associated with miscarriage. Thanks for reading! Dr T
At Wed Jan 09, 08:41:00 AM 2008,
Gillian said…
Hi Dr. T!
Thanks so much for answering me! I'm sensitive to anti-E.
Looking forward to hearing back from you!
Gillian
At Sun Jan 13, 10:56:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Gillian Jan 9: ne of the Rh-antigens so the fact that you have developed antibodies to it, means you will be followed just as we would if you had Rh-D isoimmunization. I wrote a post on that earlier last year if you are interested. Again, this isoimmunization is NOT typically associated with birth defects or miscarriage, but does put the baby at risk for anemia and complications of that depending on how severe it is IF the baby is E-antigen positive. You could find out if there is a chance the baby is E-negative by first having your husband screened. If he was the father of your last baby, he must have at least one dose of the E gene, but if he has JUST one dose, the baby only has a 50/50 chance of being E-positive because you MUST be E-negative yourself. If the baby is E-negative then, the antibodies you have cannot ac=ffect the baby and the pregnancy becomes much less complicated. Your doctors could test the baby by doing an amniocentesis if your husband is heterozygous (has only one E gene) to find out for sure what the baby is. Other than that, you will simply have your antibody titer checked regularly and if the titer is low and does not rise significantly, the baby will be at low risk. If it does rise, the baby is probably E-positive and therefore at risk. Most specialists now screen primarily for fetal anemia by doing noninvasive Doppler flow studies on the baby's middle cerebral artery. Anyway, the odds are in your favor that both of you will do just fine during the pregnancy. Best of luck to you and let us know what happens and how things turn out. Dr T
At Tue Jan 22, 06:55:00 AM 2008,
Gillian said…
Thank you so much for answering my question! You've been a great help.
Best wishes.
Gillian
At Tue Jan 22, 06:30:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
You're welcome Gillian! Dr T
At Thu Apr 03, 11:31:00 AM 2008,
Anonymous said…
I am 28 years of age and I am RH negative. I found this out when I found out I was with child when I was 22. I had a miscarrige, which I am at peace with now. My Husband and I have bein together for 6 years now, and I am not on birth control. If it happens it happens, and we are ready for any sign of a child. I am worried that in order to even have the chance to become with child I would need to go and recieve these shots before I am even able to concieve. I would like to know if I get these shots will I be more fertile and increase my chances of becomeing pregnant????
At Thu Apr 03, 04:22:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Apr 3: NO! You do not need to have the shots before you conceive and they will NOT make you more fertile. But, if you have gone 6 years without conceiving, and want to have a baby, then please go see someone who can figure out why you have been infertile since the miscarriage and help you before too much more time passes. Thanks for reading and for your question.
At Tue Jul 22, 08:45:00 AM 2008,
Kimberly said…
I was just told by my Obgyn yesterday that I am RH - and he is sending me for the Rh immune-globulin shot in two weeks. My question is how is this shot given. I am TERRIFIED of needles and I have blood work and glucose testing that same morning (the Rh immune-globulin shot is in the afternoon) I've looked everywhere online but there was no answers to how it was given. I've had demerol and morphine shots before in the butt cheek, and Buscopin in the hip. If you could get back to me that would be sooo great!
Thanks.
At Wed Jul 23, 12:44:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
Hi Kimberly: Well, at least you are going to get all your "shots' out of the way in one day. Rhogam is given by injection with a very LARGE needle - directly into your heart! No, JUST KIDDING - it is an intramuscular injection with a relatively thin needle, usually into the upper arm. You will be fine and I apologize for the little scare! Good luck. Dr T
At Fri Jul 25, 08:12:00 AM 2008,
Kimberly said…
Thanks for scaring the crap outta me!!! but thankyou! that was very helpful. I'm still not entirely confident but it does help knowing how the shot is given!
Thanks for you help!!
At Fri Jul 25, 07:22:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Kimberly: You're welcome. I do have a strange sense of humor, but figured you could take it. Just think about what I said while you're getting the shot! Dr T
At Fri Sep 19, 01:45:00 PM 2008,
crystal said…
I am 22 weeks and at my 20 week appt. the nurse told me that I have A- blood type so that means I need the shot. Well I asked the OB and he didn't really explain it to me... My husband is O- blood type(his mother has the RH factor) They did not explain to me why I have to have this shot. Can you please help me out with this. B/c i'm due to get the shot at 28 weeks and if I don't really need it then I don't want it, but I don't want to harm my baby in any way.
At Tue Sep 23, 06:34:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Crystal: If your husband is Rh-negative (and you are absolutely sure he is the father of your baby), then you do NOT need to have the shot. Your baby must be Rh-negative too since you both are! Just refuse it. They cannot MAKE you take it! Dr T
At Sat Nov 15, 07:25:00 PM 2008,
Anonymous said…
I had 1 fetal death due to rh ,since i am 16 weeks i had amiocentecis they gave me a rhogram do i need one at 28 weeks also?
At Fri Nov 28, 10:30:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Nov 15: I am confused. If you are already Rh-sensitized, you do NOT need rhogam at all. In fact you could be a 'rhogam donor.' Please clarify your situation to me. Why do you think you lost a baby because of Rh problems? Dr T
At Mon Dec 01, 09:34:00 PM 2008,
Anonymous said…
My waters broke last week and I lost my baby at 18 weeks. I had a D&C and went back for a check-up today. The doctor informed me that I am RH-. I didn't know this before. He said I need to come back in 2 days to have a shot to protect any future pregnancies. I've heard that I need to have that shot within 72 hours of the D&C. Is that correct? Is having the shot over a week after the D&C still ok? Will it be effective? Are there any risks? I appreciate your time and help.Thank you very much.
At Fri Jan 23, 06:02:00 PM 2009,
Joy, Arkansas said…
I'm 28 weeks and need rhogam but I have a phobia of kneedles. My doctor is aware of this and has been great with me. He says rhogam is only available in an injection or IV. My question is can I get any other medication or even rhogam in any non-injection form. My body goes into major panic when kneedles are even mentioned, so I'm desprite for any other treatment methods. Please Help Me!!
At Tue Feb 03, 05:55:00 AM 2009,
typealice said…
Hi Dr T, it's me, Gillian again!
My husband (the father of my first child) and I have decided to get pregnant again. He hasn't had blood tests done yet, but I was warned by a doctor that if there are antibodies present that they will likely want to induce me around 37 weeks of pregnancy to try to keep the baby as healthy as possible.
Have you heard about this method? Is it a good idea? I'm really all about natural parenting and don't like the idea of interventions like that.
What are the risks for the baby becoming anemic while in utero or when they're out of my body? I'm terrified of physical or mental abnormalities.
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