ISOIMMUNIZATION
In this informative article, Dr. Donna D. Johnson explains the concept of isoimmunization, shedding light on its significance in the medical field. The content delves into the complexities and implications of isoimmunization, offering valuable insights for healthcare professionals and individuals seeking to broaden their knowledge on this topic.
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Presentation Transcript
ISOIMMUNIZATION ISOIMMUNIZATION Donna D. Johnson, MD
PREVENTION PREVENTION Rh D immune globulin (rhogam) introduced in 1970 s the rate from 13 16% to 0. 5 1.8% the rate to 0.14 0.2% with antepartum administration ACOG, PB 181, 2017
WHO SHOULD GET RH D IMMUNE GLOBULIN? WHO SHOULD GET RH D IMMUNE GLOBULIN? Chorionic villus sampling, amniocentesis, cordocentesis Threatened miscarriage or miscarriage Ectopic pregnancy Evacuation of molar pregnancy Medical or surgical termination of pregnancy Antepartum hemorrhage Abdominal trauma Intrauterine fetal demise External cephalic version Delivery ACOG, PB 181, 2017
DOSE OF RH D IMMUNE GLOBULIN DOSE OF RH D IMMUNE GLOBULIN 50 gm (5 ml) < 12 weeks 120 gm (12 ml) < 12 weeks 300 gm (30 ml) > 12 weeks
DO Du POSITIVE PATIENTS DO Du POSITIVE PATIENTS NEED RH D IMMUNE GLOBULIN? NEED RH D IMMUNE GLOBULIN? Historically: no American Association of Blood Banks (AABB): rh negative Now: Yes
SHOULD I GET AN ANTIBODY SCREEN PRIOR SHOULD I GET AN ANTIBODY SCREEN PRIOR TO 28 week RH D IMMUNE GLOBULIN? TO 28 week RH D IMMUNE GLOBULIN? Most guidelines: yes Cost vs. risk
I FORGOT THE RH D IMMUNOGLOBULIN PP I FORGOT THE RH D IMMUNOGLOBULIN PP Ideally, <72 hours after delivery Suggested up to 28 days after delivery ACOG, PB 181, 2017
ISOIMMUNIZATION ISOIMMUNIZATION Positive antibody screen Identify the antibody Take a history re: pregnancies & blood transfusions Take a history about affected children Quantify the antibody screen
PATERNAL STATUS PATERNAL STATUS Discuss paternity with the patient alone Check the father of the baby for the antigen status Determine homozygosity vs heterozygosity Mother has an anti D antibody FOB DD or Dd 100% of children has D antigen with DD genotype 50% of children had D antigen with Dd genotype
QUANTITATE THE ANTIBODY QUANTITATE THE ANTIBODY 1:1 1:2 1:4 1:8 1:16 1:32
QUANTITATE THE ANTIBODY QUANTITATE THE ANTIBODY < 1:8: repeat monthly > 1:8: refer to MFM EXCEPTION: Kell
MIDDLE CEREBRAL ARTERY DOPPLER: MIDDLE CEREBRAL ARTERY DOPPLER: PEAK SYSTOLIC VELOCITY PEAK SYSTOLIC VELOCITY glowm.com
MARI CURVE MARI CURVE
Project ECHO South Carolina Pregnancy Wellness Visit Our Website: https://sctelehealth.org/services/pregnancy-wellness 1st & 3rd Wednesday/Month Postpartum Hemorrhage 12:15 pm 1:00 pm Date Topic 11/3 Hemogobinopothies
