To rhesus-negative woman for prevention of Rh 0 (D)
sensitisation, following any potentially sensitising
episode (e.g. stillbirth, abortion, amniocentesis) up to
20 weeks’gestation
▶BY DEEP INTRAMUSCULAR INJECTION
▶Females of childbearing potential: 250 units per episode,
dose to be administered immediately or within
72 hours, subcutaneous route used for patients with
bleeding disorders
To rhesus-negative woman for prevention of Rh 0 (D)
sensitisation, following any potentially sensitising
episode (e.g. stillbirth, abortion, amniocentesis) after
20 weeks’gestation
▶BY DEEP INTRAMUSCULAR INJECTION
▶Females of childbearing potential: 500 units per episode,
dose to be administered immediately or within
72 hours, subcutaneous route used for patients with
bleeding disorders
To rhesus-negative woman for prevention of Rh 0 (D)
sensitisation, antenatal prophylaxis
▶BY DEEP INTRAMUSCULAR INJECTION
▶Females of childbearing potential: 500 units, dose to be
given at weeks 28 and 34 of pregnancy, if infant rhesus-
positive, a further dose is still needed immediately or
within 72 hours of delivery, subcutaneous route used
for patients with bleeding disorders
To rhesus-negative woman for prevention of Rh 0 (D)
sensitisation, antenatal prophylaxis (alternative NICE
recommendation)
▶BY DEEP INTRAMUSCULAR INJECTION
▶Females of childbearing potential: 1000 – 1650 units, dose
to be given at weeks 28 and 34 of pregnancy,
alternatively 1500 units for 1 dose, dose to be given
between 28 and 30 weeks gestation
To rhesus-negative woman for prevention of Rh 0 (D)
sensitisation, following Rh 0 (D) incompatible blood
transfusion
▶BY DEEP INTRAMUSCULAR INJECTION
▶Females of childbearing potential: 100 – 125 units per mL
of transfused rhesus-positive red cells, subcutaneous
route used for patients with bleeding disorders
RHOPHYLAC®
To rhesus-negative woman for prevention of Rh 0 (D)
sensitisation, following birth of rhesus-positive infant
▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION
▶Females of childbearing potential: 1000 – 1500 units, dose
to administered immediately or within 72 hours; for
large transplacental bleed, extra 100 units per mL fetal
red cells (preferably by intravenous injection),
intravenous route recommended for patients with
bleeding disorders
To rhesus-negative woman for prevention of Rh 0 (D)
sensitisation, following any potentially sensitising
episode (e.g. abortion, amniocentesis, chorionic villous
sampling) up to 12 weeks’gestation
▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION
▶Females of childbearing potential: 1000 units per
episode, dose to be administered immediately or within
72 hours, intravenous route recommended for patients
with bleeding disorders, higher doses may be required
after 12 weeks gestation
To rhesus-negative woman for prevention of Rh 0 (D)
sensitisation, antenatal prophylaxis
▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION
▶Females of childbearing potential: 1500 units, dose to be
given between weeks 28 – 30 of pregnancy; if infant
rhesus-positive, a further dose is still neededimmediately or within 72 hours of delivery,
intravenous route recommended for patients with
bleeding disorders
To rhesus-negative woman for prevention of Rh 0 (D)
sensitisation, following Rh 0 (D) incompatible blood
transfusion
▶BY INTRAVENOUS INJECTION
▶Females of childbearing potential: 50 units per mL of
transfused rhesus-positive blood, alternatively
100 units per of mL of erythrocyte concentrate,
intravenous route recommended for patients with
bleeding disorderslCONTRA-INDICATIONSTreatment of idiopathic
thrombocytopenia purpura in rhesus negative patients.
treatment of idiopathic thrombocytopenia purpura in
splenectomised patients
lCAUTIONSImmunoglobulin A deficiency.possible
interference with live virus vaccines
CAUTIONS, FURTHER INFORMATION
▶MMR vaccineMMR vaccine may be given in the postpartum
period with anti-D (Rh 0 ) immunoglobulin injection
provided that separate syringes are used and the products
are administered into different limbs. If blood is
transfused, the antibody response to the vaccine may be
inhibited—measure rubella antibodies after 6 – 8 weeks and
revaccinate if necessary.
lSIDE-EFFECTS
▶UncommonChills.fever.headache.malaise.skin
reactions
▶Rare or very rareArthralgia.dyspnoea.hypersensitivity.
hypotension.nausea.tachycardia.vomiting
▶Frequency not knownIntravascular haemolysis
lHANDLING AND STORAGECare must be taken to store all
immunological products under the conditions
recommended in the product literature, otherwise the
preparation may become ineffective.Refrigerated
storageis usually necessary; many immunoglobulins need
to be stored at 2 – 8 °C and not allowed to freeze.
Immunoglobulins should be protected from light. Opened
multidose vials must be used within the period
recommended in the product literature.
lNATIONAL FUNDING/ACCESS DECISIONS
NICE decisions
▶Routine antenatal anti-D prophylaxis for rhesus-negative
women (August 2008 )NICE TA156
Routine antenatal anti-D prophylaxis should be offered to
all non-sensitised pregnant women who are rhesus
negative.
http://www.nice.org.uk/TA156lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶D-Gam(Bio Products Laboratory Ltd)
Anti-D (RHO) immunoglobulin 500 unitD-Gam Anti-D
immunoglobulin 500 unit solution for injection vials| 1 vialP
£ 33. 75
Anti-D (RHO) immunoglobulin 1500 unitD-Gam Anti-D
immunoglobulin 1 , 500 unit solution for injection vials| 1 vialP
£ 58. 00
▶Rhophylac(CSL Behring UK Ltd)
Anti-D (RHO) immunoglobulin 750 unit per 1 mlRhophylac
1 , 500 units/ 2 ml solution for injection pre-filled syringes| 1 pre-filled
disposable injectionP£ 46. 50772 Immunoglobulin therapy BNFC 2018 – 2019
Vaccines14