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

I believe the package insert says if given IV: 1mL per 15 to 60 seconds. So they could give all 3 vials over 3 minutes total.

I believe the package insert says if given IV: 1mL per 15 to 60 seconds. So they could give all 3 vials over 3 minutes total.

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.

... so that the mom doesn't feel like an ITP patient with side effects and a new baby. Have anyone encountered this issue?

Thanks

Can you clarify what you mean by this?

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.

If the pharmacy is handling the RhIg, I have known them to combine the doses for IM injection to avoid multiple sticks. They can also give some in each hip to prevent too much fluid on one side. I think the IM injection helps prevent the side effects (except for the pain in the injection site).

One reason they may feel that way, is that ITP patients given RhIG are Rh positive patients and so often experience some actual hemolysis with the RhIG. These moms are Rh negative by definition and so these reactions would be limited to aberrant lots where there may be a high titer of anti-A or anti-B which are usually screened out at the manufacturing process.

I bet there would be no harm in spreading out the doses--so long as the patient keeps her IV patent.

One reason they may feel that way, is that ITP patients given RhIG are Rh positive patients and so often experience some actual hemolysis with the RhIG. These moms are Rh negative by definition and so these reactions would be limited to aberrant lots where there may be a high titer of anti-A or anti-B which are usually screened out at the manufacturing process.

I was going to post this very observation. The ITP patients given RHIG are D+ and therefore there will be an immune reaction to the anti-D and the D+ RBC. It isn't severe in most cases, and possibly non-hemolytic, but there is likely extra-vascular destruction of some D+ RBC that might account for the flu-like symptoms. This should be less likely in the D- post-partum recipient.