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ABO and Rh Incompatibility

presented by Maria Sol Solano RN IV BSN CLC IBCLC

ABO Blood Types


4 Principal Types determined by the presence of 2 antigens and 2 antibodies

Blood Type Antigen Antigen Antibody Antibody A B anti-A anti-B A B O AB yes yes yes yes yes yes yes yes

O -universal donor AB -universal recepient Rh or Rhesus factor is an antigen ABO/Rh incompatibility may result in - Erythroblastosis Fetalis - Hemolytic Disease of the Newborn

Antibody Test (Coomb's Test)

to find antibodies that attack RBC's antibodies are proteins made by the immune system bind to foreign substances such as bacteria and viruses and causes them to be destroyed

Conditions that causes antibody production

---blood transfusion reaction ---Rh sensitization

Direct Coomb's Test


done on RBC's detects antibodies attached to RBC's

Indirect Coomb's Test


done on serum detects antibodies present in the blood stream could bind to certain RBC's

Rhogam
Rho(D)Immune Globulin (Human) RhoGam 300ug MicRhoGam 50ug

Action
suppresses the immune response of Rhindividuals to Rh+ RBC's not effective in altering the course or consequences of Rh immunization once it occurred

OB Use
the Rh- OB patient may be exposed to RBC's from her Rh+ fetus during the normal course of pregnancy, after an OB procedure, or abdominal trauma

Clinical Studies
reduction of Rh sensitization in pregnancy from 12-13% to 1-2% with RhoGam administration within 72 hours PP antepartum administration at 28 wks as well as within 72 hours PP reduced the rate 0.10.2% 3 hours post abortion administration was 100% effective

Use after incompatible blood transfusion


Rh immunization can occur even with <1ml of Rh+ blood transfused RhoGam or MicRhoGam is administered within 72 hrs. post BT of incompatible RBC's

Indications
pregnancy/delivery of an Rh+ baby regardless of blood types abortion/threatened abortion at any stage of pregnancy ectopic pregnancy antepartal fetal/maternal bleed(suspect/proven) as in placenta previa,amniocentesis,CVS,PUBS,versions or abdominal trauma transfusion of incompatible blood or blood products

Contraindications
individuals known to have anaphylactic or severe systemic reaction to human globulin newborn infants

Precautions
observe patient at least 20 minutes after injection

Postpartum administration
Rh- mom has an Rh+ baby fetal bleed screen Pharmacy will deliver RhoGam med,RhoGam Injection Request Form,Pharmacy Med Form fill out Blood Bank,Pharmacy forms,and RhoGam injection control form identify patient with another nurse educate patient,give RhoGam card administer med observe at least 20 min for any reaction send appropriate documents to Blood Bank and Pharmacy

RhoGam and other vaccines


Vaccines given so the body will make antibodies to the offending agent and protect the patient from future infection RhoGam given to prevent the body from making antibodies after being exposed to Rh+ blood

if the body makes its own antibodies to Rh+ blood(in an Rh- person)the body will react to the Rh+ blood as if it is foreign,so it will attack any Rh+ blood administered,or any future fetus Rhogam is given to trick the body so it won't make its own antibodies.

Giving a vaccine won't be a good idea,because we give vaccines hoping the patient will make antibodies and if they just had a dose of RhoGam,they shouldn't be making antibodies.

2 Alternatives
withold the vaccines for a few months give the vaccines,instruct patient to check titers later to see if it worked it wouldn't hurt to give it,it just might not work

IT IS NEVER APPROPRIATE TO WITHOLD RHOGAM,vaccines can be given later,but RhoGam has a narrow window to be administered.