Kimster

It is considered a drug because it has a NDC number just like IVIG, coag products all of which are plasma derivatives.

Grifols bought Novartis Diagnostic division do a google of Grifols-Novartis and all the information is there.

Although kedrion now owns the brand Rhogam they still only have one donor site, and kedrion is such a young plasma company the other two Grifols and CSL have been around for over 100 years each.

First and foremost how does one not remember having an amnio? Second those administering the RhIG should be giving these moms the patient ID card that all of the products on the market have within the product insert. Next for your ER docs that keep administering RhIG for bleeding they should discuss with the Chief of OB and the Blood Bank Medical Director the protocol set in place by ACOG for multiple bleeding episodes.

Actually they do this on women who are not sensitized before 28 weeks. If the baby is negative (40% of the time with an Rh positive dad) then they would not have to have either dose of RhIG antenatal or post partum. And this would be in instances where they know for sure who the father is (10%) of all births are not the stated father in the US. If you do a search of the internet of HDN a mother who is not knowledgeable about the high safety rate of plasma based products would be scared to death to have a RhIG injection let alone all the misinformation on vaccines. So there are moms that will pay for this test no matter what the OB says.

I heard about this company about 5 years ago, at that time only NY used the test. Myself and a few friends have encountered a few OB offices utilizing this testing, (not that often) it is still very expensive and not sure if the insurance companies are covering or out of pocket for those who are paranoid about blood based products. I know at one time it could not detect Rh in some blood types or something like that. http://laboratories.sequenom.com Hope everyone had a safe and great Memorial Day! K

I met this lovely gentleman at the CABB meeting after he had given one of his great presentations on Rh, I talked to him after the presentation was just knocked over by his patience for with my questions.

We actually got rid of the micro-dose because first it was ordered for patients that were not candidates for a mini dose. Second the price was almost the same as a full dose and why worry about the having two to stock. It is always better to give more than not enough, many OB patients due dates may be changed after the first trimester to an earlier date. Look at Ramsey et al in Arch of Pathology Lab Med, March 2009 regards to underdosing, I'd rather be safe than sorry.

Gee, I didn't think HyperRho even existed anymore. Always was considered the cheap Rhogam because it only had one viral removal step. Plasma products these days always have two or more. We use Rhophylac IM at 28 weeks and then IV post partum, mom's really like that

All RhIG products have a NDC number-rhogam, HyperRho, Winrho and Rhophylac.

John, I would look at any publications by Giancarlo Mari MD at University of TN, the doppler is his topic and also Ken Moise MD he really is the guru of HDFM.

Not sure if this would interest you, but there is concern on Rh negative pregnant women over 28BMI and absorption of RhIG by intramuscular administration. The Woefler study in Transfusion 2007 showed a dramatic drop in absorption after 3 days in these women. And as we know it takes up to 7 days for a preventive titer to be absorbed, this could put them at risk of sensitization. Just a thought.

ITP patients who are treated with RhIG typically have chills, fever, kind of a flu feeling post treatment. They usually are given tylenol and benadryl to counteract some of the symptoms. Once again RhIg is dosed by weight, something we do not generally take into consideration if more than one syringe is needed, I am talking about those rare occasions where perhaps 4 syringes are needed, that would be 1200 mcg of RhIG. Moms with new babies are not going to want to feel like they have the flu.

I realize the timing, I mean we do not think of total dose vs the weight of the patient and could she tolerate such a dose all at one time. Should they be spaced out over a period of time? I think we need to look at multiple dosing differently when giving IV, but not sure what we should do.

I was wondering on moms who need more than 3 syringes of RhIG how would you have the nurses administer it? Now that we have an RhIG that can be given IV (Rhophylac), do we have them administer it like they do for ITP where it is based on 50-75mcg/kg. They might need to split out the dose so that the mom doesn't feel like an ITP patient with side effects and a new baby. Have anyone encountered this issue? Thanks

BDI is a really good distributor, but there is more to the difference than IM and IV administration between Rhogam and Rhophylac. In Transfusion I think it was 2007 was a study on Rh negative women that talked to BMI, women that were 28BMI and after 3 days dramatically dropped absorption of RhIG. These women never reached a preventive titer. Several things were thought to be the cause but one that stood out to us was the possibility of administration being subq rather than IM. Not like it is pain meds and we can give more later. Our doctors thought the needle that is permanently attached to the Rhogam syringe was too short for IM administration, and whenever possible it should be given post partum IV. Rhophylac has a separate needle which is a standard size for IM and if the patient is smaller the outpatient dept can change to a shorter needle. Inpatients we mark the RH negative moms IV's with a sticker saying RH negative, then saline lock them post delivery, a little bit of learning curve to get use to keeping the IV's.

If you contact medical affairs of any of the companies that make an RhIG, they can send a letter which states the room temp for their product. Actually none of the US RhIG's have ever had a 9 months time table. Rhogam and HyperRho are significantly shorter. There is another thread on this subject too.

It will be interesting to see what Ortho has in store since the Rhogam is sold to Kedrion as of July 31st, I would think all of our contracts will be null and void that has Rhogam in them. Otherwise Briccos in the North End is superb Italian food.

I have attached a case study from Ben Taub in Houston, Dr. Werch had 2 cases related to trauma and each were treated for the amount of infused RBC's. This was a poster presentation at AABB, then she submitted the study for publication.[ATTACH]630[/ATTACH]

I know my hospital discontinued using the mini dose for 3 reasons: 1. Cost-usually it isn't priced much less than the full dose. 2. It is better to have too much than not enough, many women have the due dates moved up after the first trimester. 3. OB 's mis-order the mini dose when a full dose should be used, the doctor then has to be tracked down for the order to be changed.

When we changed our computer system we lost the flow chart for the order of thest to be done on a Rh-negative mom post partum does anyone have one, trying not to re-invent the wheel Thanks, Kim

Please remember that non-apheresis platelets have more RBC's within the unit. It has been shown that as little as 0.1ml of RBC's can cause alloimmunization in an Rh-negative patient.

As mentioned earlier, 10% of all pregnancies the husband is not the father. It brings back memories of a case in the 80's we had at the hospital. The boyfriend was visiting and the husband arrived and shot him in the heart, fortunately our thoracis surgeon happened to be in the hospital. Kim

In the US we give the RhIgD in 2 doses- 1500IU or 300mcg at the beginning of the third trimester (28 weeks) then at least another 1500IU within 72 hours of the delivery of a Rh-positive fetus, more if warranted by the Coombs and KB testing.

I know of an Maternal Fetal Specialist that was creating a slide deck on HDN and the information he found actually suggested that Catherine of Aragon was Rh-, she was of Spanish lineage, which we know the Basque region has the highest percentage of Rh negativity.