Pregnancy Termination and Rhogam

[ackkap]

When a Rh negative woman has a pregnancy terminated,  at what week gestation will your facility give a dose of Rhogam without performing a Kleihauer-Betke (or Flow Cytometry)?  Currently at our hospital, less than 13 week gestation has Rhogam issued without a Kleihauer-Betke.  Greater than 13 week gestation, a Kleihauer-Betke is performed before Rhogam is issued.  Thanks!

[David Saikin]

We use 12 weeks.  I know places that use 20. 

[Carrie Easley]

We are 20, and only give full dose (no micro).

[jalomahe]

20 Weeks. Theory behind it is that the prior to 20 wks even if the total volume of blood from the fetus were to have crossed the placenta and entered the maternal circulation it would not be enough to exceed what is covered by a single full dose of RhIg. Also we only issue full doses, we do not stock micro-doses.

[JessieBeeley]

We currently use 12 weeks as well and only stock full doses.  For those facilities using 20 weeks:  Are you willing to share the references you are citing for the 20 week fetus having a < 30 ml blood volume?

 

[AMcCord]

We do a fetal bleed screen if >13 weeks. No micro doses.

[Carrie Easley]

https://www.uptodate.com/contents/prevention-of-rhesus-d-alloimmunization-in-pregnancy?search=RhIg pregnancy termination&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

We do a K-B after 20 weeks if we don't get cord blood.  A single, full dose if < 20 weeks.  Here's one of the sources I found.

[gagpinks]

Uk guidelines suugest, "Any senisitizing event before 20 weeks not required KB test however lady required Rhogam .  After 20 weeks, any senisitizing event required KB as well as anti-D depending on the bleed.