Hi! Im new here and i have a question regarding on one of the topics ...

How my Rhogams should a Type O positive Male px recieve if he was transfused with 2 O positive PRBC during a bleeding episode... should we follow the 15ml PRBC/30mL WB = 1 vial then +1 vial if recieved more >15ml PRBC/30mL WB ???

Thanks!

try ro read RHig insert.

We would probably give none to an Rh neg MALE who received Rh pos RBCs.

yeah i've read the inserts...so that means if the guy recieved 2 LRPCs(450mL each) he gets to get 60 freakin vials? ! ... well thanks, just want to confirm if im thinking it right...

What kind of response is to read the package insert!?

I hate the attitude.

Edited December 1, 200816 yr by srochelle
POOR THOUGHT

I've never seen RhIg prevent sensitization to Rh+ rbc transfusions - and yes 720 mL of red cells divided by 15 mL = 48 vials+1. Are your red cells 450 mL or is that the whole blood? My red cells are ~350 mL. Are you giving it for free?

I would not even consider giving this patient any RhIG.

I would not give a male patient RhoGAM either. If it was a female of childbearing age, I would go for IV Rh immune globulin, rather than IM. Pharmacy would be your friend in that project.

During AABB this year, Dr. Werch out of Ben Taub in Houston had a abstract poster on this subject. Although this was based on females of child bearing years, it gave two scenarios on the treatment. Also Dr. Jay Herman out of Philadelphia had a paper in Transfusion this past year on mismatched blood transfusions.

Most people do not worry about males being treated for this but some do treat. In Dr. Werch's paper she discussed a patient who received 2 units of PRBC's, but the calculations will vary by the amount of PRBC's in each unit. Most are around 200-250cc, which works out to around 16-17 syringes of Rh Immune Globulin per unit. Rhogam use to have a maximum dosage of 3000mcgs. not sure if they still do but that would be only 10 syringes. In both if Dr. Werch's cases she gave the product IV. There are two IV formulas on the market, WinRho and Rhophylac. She used the latter.

17 syringes of RhIG would wipe out my entire inventory. I would rather let a male build an Anti-D than not have RhIG available for any women that might need it.

He could always become a Rh plasma donor if he becomes sensitized. Depending on where he lives and if there is a plasma center with such a program nearby.

thank you so much for the replies! by the way on the 450 ML thing, i just overexaggerated it to really emphasize the number of RHig to be given and we only have 1 box of RHig, so i doubt we can give it all away to some dude.

thanks again everyone, i appreciate it

We probably wouldn't give the RhoGam here either. If we did, we would probably give the IV version, WinRho...that many IM needles is just not nice.

What kind of response is to read the package insert!?

I hate the attitude.

The reason I said to check the inserts...because I do not have one at home and do not remember calculation(I refered to package insert in past to calculate the number of vials). If your clinician wants to give RhoGham you have no choice you have to give. We had such a case at my hospital where trauma patient got Rh postive blood and clinician insisted that he wanted to give Rhogam so we ended up giving WinRHo.

Just an FYI, there is another IV Anti D- Rhophylac. It is about 1/3rd of the price of WinRho, also usually cheaper than Rhogam too. That is what Dr. Werch used in her cases in her abstract.

I think anyone giving RhIG in these circumstances either IV or IM should consider the affect of this amount (2 units!) of red cell destruction on the patient before they administer the RhIG. We would not give it in this situation. If a doctor ordered it, our pathologist would talk to them first.

Linda Frederick

Linda, I agree. Unless the patient is female and of child bearing age should this be an issue. And then I would space the dose of Anti-D over several days.

I wouldn't give an O pos recipient Rhogam, male or female.

Sounds like a pathologist issue to me. I'd evaluate the patient for post-transfusion hemolysis (haptoglobin, LDH, urine dipstick) before any Rhogam would be considered, male or female. We probably wouldn't waste Rhogam on a male patient anyway. Make all the Anti-D you want, buddy!:cool: