Immunoglobulins

17 Immunoglobulins


These are antibodies, present in the blood, that by specific and direct action defend the body against invading bacteria or organisms. Anti-D immunoglobulin is used prophylactically and in treatment of rhesus iso-immunization in women whose blood is rhesus negative. This immunoglobulin, given via injection, coats fetal cells that may have leaked into the maternal circulation following a sensitizing episode, thus preventing the woman becoming rhesus iso-immunized.


Some antibodies that are present in maternal blood require consultation with the Regional Blood Transfusion Centre as to their relevance to the mother and the fetus/neonate.


Other uses of immunoglobulins include those used as vaccines, i.e. hepatitis, varicella, rubella, tuberculosis, rabies and tetanus, some of which are discussed in Chapter 20.


The student should be aware of:



image blood grouping and rhesus evaluation


image the aetiology of Rhesus iso-immunization


image prevention of iso-immunization


image what action should be taken when there is a possibility that iso-immunization could occur, e.g. in antepartum haemorrhage


image counselling to prevent iso-immunization


image the sequelae to mother and fetus/neonate of rhesus iso-immunization


image the RCOG and NICE guidelines for administration of anti-D in pregnancy


image an awareness of other antibodies present in blood, e.g. Lewis, Kell, Duffy anti-E and anti-Fy, etc.


image the sequelae of infection by varicella zoster in pregnant mothers and neonates


image the administration of immunoglobulin to ameliorate the effects of such infection


image the RCOG guidelines for treatment of varicella zoster contacts.


When evaluating serum titres, the date of the last dose of anti-D should be included on the request document as the antibodies persist in circulation and may give a falsely high reading.




BP

Anti-D (Rh) immunoglobulin

Proprietary

D-GAM® Anti-D Rh Immunoglobulin (BPL) – available in 250 IU, 500 IU, 1500 IU and 2500 IU vials – doses according to haematologist instructions
Rhophylac® (CSL)

Group

Immunoglobulins – specific

Uses/indications

Prevention of RhD immunization in RhD-negative women:

• pregnancy/delivery of a RhD-positive baby


• abortion/threatened abortion, ectopic pregnancy or hydatidiform mole


• after antepartum haemorrhage (APH), amniocentesis, chorionic biopsy or obstetric manipulative procedure, e.g. external cephalic version, or abdominal trauma that may cause transplacental haemorrhage (TPH)


• treatment of RhD-negative patients after transfusion of RhD-positive blood or other products containing RhD-positive red blood cells (e.g. platelets)

Rhophylac® (CSL) – see BNF and SPC for detail

Type of drug

POM

Presentation

Solution for injection

Dosage

Postnatal dosage: the recommended dose is 500 IU as soon as possible within 72 h of delivery (additional doses of anti-D should be considered if a large fetomaternal haemorrhage (FMH) is suspected)
Antenatal prophylaxis: 500 IU given at both 28 and 34 weeks of gestation, or a single dose of 1500 IU at 28 weeks’ gestation
Following a potentially sensitizing event during pregnancy: administered as soon as possible and no later than 72 h after the event

• up to 20 weeks’ gestation: recommended dose is 250 IU per incident


• after 20 weeks’ gestation: recommended dose is 500 IU per incident (a test for the size of the FMH should be performed when anti-D is given after 20 weeks and additional doses of anti-D should be administered as indicated)

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  4. Hypoglycaemics

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Jul 11, 2016 | Posted by in MIDWIFERY | Comments Off on Immunoglobulins

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