Anti-Rhesus immunoglobulin against Rh-conflict. Anti-Rhesus immunoglobulin - instructions for use and indications, release form and price Interaction with other drugs

Human anti-Rhesus immunoglobulin Rho(D) is used to prevent Rh-conflict in Rh-negative women who are not sensitized to the Rho(D) antigen (i.e., have not developed Rh antibodies) under the condition of: pregnancy and birth of a Rh-positive child, with artificial and spontaneous abortion, with termination of an ectopic pregnancy, with the threat of termination of pregnancy at any stage, after amniocentesis and other procedures associated with the risk of fetal blood entering the mother’s bloodstream, as well as in the event of an abdominal injury.

Contraindications Human immunoglobulin anti-rhesus RhO(D) solution for intramuscular injection 0.3 mg/dose 1 ml

Administration of human anti-Rhesus immunoglobulin Rho(D) is contraindicated in Rh-positive postpartum women; Rh-negative postpartum women sensitized to the Rho(D) antigen (in whose blood serum Rh antibodies are detected).

Method of administration and dosage Human anti-rhesus immunoglobulin RhO(D) solution for intramuscular injection 0.3 mg/dose 1 ml

Human anti-rhesus immunoglobulin Rho(D) is used only intramuscularly. Before injection, ampoules with the drug are kept for 2 hours at room temperature (20±2) °C. To avoid foam formation, the drug is drawn into a syringe with a wide-bore needle. The drug cannot be stored in an opened ampoule. One dose (300 mcg) corresponds to 1 ml with an antibody titer of 1: 2000 or 2 ml with an antibody titer of 1: 1000. During pregnancy, in Rh-negative women without sensitization phenomena, nonspecific desensitizing therapy is performed at a period of 10-12, 24-25, 32 -33 weeks of pregnancy. Human anti-rhesus immunoglobulin Rho(D) is administered in one dose (300 mcg) intramuscularly. In case of RH(+) (positive Rh factor) of the husband's blood, administration of anti-Rhesus immunoglobulin Rhо(D) 300 mcg intramuscularly at 28-30 weeks. Repeated administration of immunoglobulin no later than 48-72 hours after birth at the birth of an Rh-positive child. In case of artificial termination of pregnancy during pregnancy more than 13 weeks, it is recommended to administer one dose of the drug (300 mcg). If pregnancy is terminated at less than 13 weeks, it is recommended to administer 50 mcg of the drug. In case of injury to the abdominal organs during the second or third trimester of pregnancy, it is recommended to administer one dose of the drug (300 mcg). If abdominal trauma requires administration of the drug at 13-18 weeks' gestation, another dose (300 mcg) should be administered at 26-28 weeks' gestation.

If a pregnant woman has an Rh-negative blood type, and the father of the unborn child is positive, and the fetus inherits his Rh factor, an Rh conflict may occur. To exclude the development of complications against this background, the woman is given immunoglobulin during pregnancy.

This measure helps reduce the risk of hemolytic disease of the newborn. In addition, it provides the necessary protection during subsequent pregnancies and reduces the risk of Rh conflict between mother and fetus.

During the first pregnancy, conflict rarely arises, since antibodies work like allergens when they first begin to be produced. Then they accumulate and with each subsequent pregnancy the antibody titer increases, which leads to the destruction of red blood cells in the fetus. All this leads to hemolytic disease, which is accompanied.

To prevent Rh conflict during pregnancy, anti-Rhesus immunoglobulin is used.

Anti-D immunoglobulin is the active protein fraction of human plasma. Contains IgG with incomplete anti-Rho(D) antibodies. The drug reaches its maximum concentration one day after administration.

If the mother has negative blood and the father has positive blood, it is necessary to register with the antenatal clinic before 12 weeks of pregnancy, when the first tests are done, so you need to ask the doctor about the need to administer immunoglobulin while planning pregnancy.

Subsequently, the antibody titer is determined once every 28 days if their content is negative. After the 30th week of pregnancy, antibodies are determined once every 14 days, and after the 36th week - once every 7 days.

Administration of the drug after childbirth is necessary to reduce the formation of antibodies during repeated pregnancies.

There is no need to administer immunoglobulin G during pregnancy and after childbirth if the child's father has a Rh-negative blood type.

Indications and contraindications for the use of immunoglobulin during pregnancy

The circulatory systems of the mother and fetus operate autonomously: their blood does not mix with each other. Rh conflict can occur when the placental barrier is damaged.

Human immunoglobulin during pregnancy is used to prevent isoimmunization of a woman when:

• amniocentesis;
• cordacentesis;
• injuries of the abdominal organs;
• the birth of a Rh-positive child;
• positive blood from the child's father;
• prevention of Rh conflict during the first pregnancy in the absence of sensitization of the woman;
• premature;
• severe form;
• a number of infectious lesions;
• diabetes mellitus

Among the contraindications to the use of immunoglobulin during pregnancy are:

• allergic reactions;
• negative blood group in women who have sensitization with the presence of antibodies;
• positive Rh factor in a woman.

Methods of application

Normal human immunoglobulin during pregnancy is administered intramuscularly once. One dose of the drug is 300 mcg of anti-D immunoglobulin if the antibody titer is within 1:2000, or 600 mcg if the antibody titer is 1:1000.

It is forbidden to give an intravenous injection of immunoglobulin G during pregnancy.

Before use, it is necessary to leave the drug at a temperature of 18-22 ° C for 2 hours. To avoid foam, immunoglobulin is drawn into a syringe with a wide-lumen needle. An opened ampoule should be used immediately. Storing it open is unacceptable.

The drug is administered according to the following scheme:

• the woman receives the injection within 48-72 hours after the birth of the child;
• An injection of immunoglobulin for termination of pregnancy is performed after an abortion has been performed for a period longer than that.

If there are no antibodies in blood tests, immunoglobulin is administered at 28 weeks of pregnancy for prophylactic purposes. Next, the drug is injected after birth within 48 hours if the child’s Rh factor is positive. If the child has negative blood, then repeated administration of immunoglobulin is not required.

If a Rh-negative woman is at risk of spontaneous miscarriage, it is necessary to administer 1 dose of anti-D immunoglobulin during pregnancy.

For preventive purposes, an additional injection is prescribed during pregnancy, if amniocentesis is performed, or the woman experiences an abdominal injury. Next, the drug is administered according to the specified periods.

Consequences

The administration of normal human immunoglobulin during pregnancy may be accompanied by a number of side effects, among which the most important are:

• redness of the injection site;
• increase in body temperature to 37.5 °C in the first 24 hours after injection;
• dyspeptic disorders;
• allergic reactions, including anaphylactic shock.

Due to the fact that the drug is highly allergenic, after its use the woman’s condition is monitored for half an hour. If an anaphylactic or allergic reaction develops, first aid medications are administered.

Camrou is an immunological protein fraction that was isolated from donor plasma.

Indications for use

The drug is prescribed in the following cases:

• At risk of premature birth
• In case of fetal injury (blow to the abdomen)
• During the first pregnancy in mothers with weakened immune systems.

Composition of the drug

1 ml of solution contains: 750 IU immunoglobulin (anti-rhesus Rh 0 D), glycine, water for injection.

Medicinal properties

Camrou contains anti-Rhesus immunoglobulin, making it effective in preventing isoimmunization of an Rh-negative mother who has been exposed to Rh-positive fetal blood.

After administration, antibodies are detected in the blood within 24 hours. The duration of elimination from the body takes 5 weeks.

The medicine is excreted primarily by the kidneys.

Release forms

Cost: 8543 rub.

Camrow is available in the form of a yellow liquid solution, which is intended for intramuscular administration.

The solution is placed in transparent glass bottles (dosage – 2 ml).

The kit also includes an injection needle.

Mode of application

The drug is administered exclusively intramuscularly. It is contraindicated to use it for intravenous administration to the patient.

Before administration, bottles with the solution must be kept for two hours at a temperature of 20-24 degrees Celsius.

To ensure that there is no foam in the solution, you only need to draw it with the needle that is included in the kit.

Once opened, vials cannot be stored. They must either be used or disposed of.

To prevent negative consequences, 1500 IU of the drug is administered one-time during the first three days after birth.

After the risk of miscarriage or premature birth arises, one dose of the drug should be administered - 1500 IU (300 mcg). If there is a suspicion that more than 15 ml of fetal red blood cells have entered the patient’s bloodstream, then the dosage should be increased by another 500 IU.

After a miscarriage at a period of no more than 13 weeks, you need to administer 1500 IU of solution.

During pregnancy and breastfeeding

Camrou can be used during pregnancy and lactation, but only for direct indications. Before starting treatment, the patient should consult a doctor.

Contraindications

The drug is not used in the following cases:

• For the treatment of bewitched children
• In case of individual intolerance to the active substance of the drug.

Precautionary measures

To ensure that the patient does not experience unwanted side effects, the following precautions should be followed when administering the drug:

• Treatment should take place exclusively under medical supervision
• Due to the risks of adverse reactions, the patient should remain in a supine position for an hour after administering the solution.
• There should be first aid medications for anaphylactic shock in the room before the injection is administered.
• Pregnant women can be immunized no earlier than three months after administration of the solution.

Cross-drug interactions

Immunoglobulin can be combined with analgesics, antibiotics and anti-inflammatory drugs. When interacting with these groups of drugs, it will not cause any unwanted reactions in the patient’s body.

It should be combined with caution with other immunomodulators, as this may enhance the effect of the drug.

Side effects

As a rule, Camrow is quite well tolerated.

Rarely, it can cause the following side effects in patients:

• Weakness
• Dyspepsia
• Hypersensitivity
• Pain at the injection site
• Burning and swelling of the muscles at the injection site.

In case of IgA deficiency (very rarely), the drug can cause anaphylactic reactions.

Overdose

There were no recorded cases of drug overdose. Presumably, if too large a dose is administered, immunoglobulin will increase side effects.

Conditions and shelf life

The ampoules should be stored in a dry and dark place at a temperature of two to five degrees Celsius.

Do not freeze.

If the solution has changed color, darkened, or a precipitate has formed on it, then it should absolutely not be administered to the patient. This indicates that it was stored under improper conditions.

Shelf life: 2 years from the date of manufacture indicated on the package. Do not use the medicine after the expiration date.

Analogs

Kamrow has the following medicinal analogues:

Hyperrow

Talecris Biotherapeutics, USA.
Price: 5569 rub.

Pros:

• Prevents isoimmunization in the Rh-negative body of a woman in labor
• Effective against the risk of miscarriage and premature birth.

Minuses:

• May cause a rise in temperature after insertion
• Immunization of women can be carried out no earlier than three months after administration of the drug.

Bairou di

Bayer Corporation, USA.
Price: from 7460 rub.

Main active ingredient: immunoglobulin a/rhesus. Release form: solution for injection.

Pros:

• May be used in conjunction with other medications
• Prevents isoimmunization of the Rh-negative mother.

Minuses:

• Cannot be administered to newborns
• Slowly eliminated (not earlier than 5 weeks after administration).

Russian name

Latin name of the substance Human immunoglobulin anti-rhesus Rho(D)

Pharmacological group of the substance Human immunoglobulin anti-rhesus Rho(D)

Typical clinical and pharmacological article 1

Characteristic. An immunologically active protein fraction isolated from human plasma or serum of donors tested for the absence of antibodies to HIV (HIV-1, HIV-2), hepatitis C virus and hepatitis B virus surface antigen. The active component of the drug is IgG, containing incomplete anti-Rho (D)-antibodies.

Pharmaceutical action. Prevents isoimmunization of a Rho(D)-negative mother exposed to Rho(D)-positive fetal blood at the birth of an Rh0(D)-positive child, abortion (either spontaneous or induced), amniocentesis, or organ trauma. abdominal cavity during pregnancy. Reduces the frequency of maternal rhesus immunization when administered within 48-72 hours after the birth of a fully term Rho(D)-positive child by a Rho(D)-negative mother.

Pharmacokinetics. Cmax of antibodies in the blood is reached after 24 hours. The half-life of human anti-rhesus immunoglobulin Rho(D) is 23-26 days. T1/2 of antibodies from the body is 4-5 weeks.

Indications. Prevention of Rh conflict in Rh-negative women who are not sensitized to the Rho(D) antigen (i.e., have not developed Rh antibodies) subject to the first pregnancy and the birth of a Rh-positive child, whose blood is compatible with the mother’s blood according to the blood group system ABO; during artificial termination of pregnancy in Rh-negative women, who are also not sensitized to the Rho(D) antigen, in the case of Rh-positive blood of the husband.

Contraindications. Hypersensitivity, Rh-negative postpartum women, sensitized to the Rh0(D) antigen, in whose blood serum Rh antibodies are detected; newborns.

Dosing. Before administration, ampoules with the drug are kept for 2 hours at room temperature (18-22 °C). To avoid foam formation, the drug is drawn into a syringe with a wide bore needle. The drug cannot be stored in an opened bottle. Cannot be administered intravenously.

IM, 1 dose, once: for a postpartum woman - during the first 48-72 hours after birth, for artificial termination of pregnancy - immediately after the end of the operation. One dose - 300 mcg at a titer of 1:2000 or 600 mcg at a titer of 1:1000.

The need for a specific dose during pregnancy may vary depending on the volume of fetal blood entering the mother's bloodstream. 1 dose (300 mcg) contains a sufficient amount of antibodies to prevent sensitization to the Rh factor, if the volume of red blood cells entering the bloodstream does not exceed 15 ml. In cases where a larger volume of fetal red blood cells (more than 30 ml of whole blood or more than 15 ml of red blood cells) is expected to enter the maternal circulation, a fetal red blood cell count should be performed using an approved laboratory technique (for example, a modified acid washout-stain method according to Kleihauer and Betke ) to set the required Ig dosage. The calculated volume of fetal red blood cells entering the mother's bloodstream is divided by 15 ml and the number of doses of the drug that must be administered is obtained. If the dose calculation results in a fraction, the number of doses should be rounded up to the next whole number (for example, if a result of 1.4 is obtained, 2 doses (600 mcg) of the drug should be administered).

For prophylaxis during the prenatal period, 1 dose of the drug (300 mcg) should be administered approximately at the 28th week of pregnancy. Then another 1 dose (300 mcg) must be administered, preferably within 48-72 hours after birth, if the newborn baby is Rh positive.

If pregnancy continues after a threat of abortion arises, at any stage of pregnancy, another 1 dose (300 mcg) of the drug should be administered. If it is suspected that more than 15 ml of fetal red blood cells have entered the maternal bloodstream, the dose must be adjusted as described above.

After spontaneous abortion, induced abortion or termination of an ectopic pregnancy at a gestational age of more than 13 weeks, it is recommended to administer 1 dose (300 mcg) of the drug (or more if more than 15 ml of fetal red blood cells are suspected of entering the maternal bloodstream) If the pregnancy is terminated at less than 13 weeks of gestation , a single use of a mini-dose (approximately 50 mcg) is possible.

After amniocentesis, either at 15-18 weeks of pregnancy, or during the third trimester of pregnancy, or if an injury to the abdominal organs occurs during the second or third trimester, it is recommended to administer 1 dose (300 mcg) of the drug (or more if entry into the abdominal cavity is suspected). maternal blood flow over 15 ml of fetal red blood cells). If abdominal trauma, amniocentesis, or other unfavorable circumstance requires administration of the drug at 13-18 weeks of pregnancy, another 1 dose (300 mcg) should be administered at 26-28 weeks. To maintain protection throughout pregnancy, the concentration of passively obtained antibodies to Rho(D) should not fall below the level necessary to prevent an immune response to Rh-positive fetal red blood cells. In any case, the dose of the drug should be administered within 48-72 hours after birth - if the child is Rh positive. If delivery occurs within 3 weeks of the last dose, the postpartum dose can be discontinued (unless more than 15 ml of fetal red blood cells have entered the maternal circulation).

Side effect. Hyperemia and hyperthermia up to 37.5 °C (during the first day after administration), dyspepsia; rarely (with hypersensitivity, including IgA deficiency) - allergic reactions (up to anaphylactic shock).

Interaction. It is possible to combine with other drugs (including antibiotics).

Special instructions. Children born to women who received human Ig anti-rhesus Rho(D) before birth may receive weakly positive results from direct tests for the presence of antiglobulin at birth. It is possible to detect antibodies to Rho(D) obtained passively in maternal serum if screening tests for antibodies are performed after antenatal or postnatal administration of human Ig to Rho(D).

Immunization of women with live vaccines should be carried out no earlier than 3 months after the administration of anti-Rhesus Ig.

Preparations in vials and syringes with damaged integrity or markings, changes in physical properties (change in color, clouding of the solution, presence of unbreakable flakes), expired, or improper storage are not suitable for use.

If the father is determined to be Rho(D) negative, there is no need to administer the drug.

After administration of the drug, patients should be observed for 30 minutes. Medical offices must have anti-shock therapies. When anaphylactoid reactions develop, antihistamines, corticosteroids and alpha-adrenergic agonists are used.

The drug is not administered to Rh-positive postpartum women.

State register of medicines. Official publication: in 2 volumes - M.: Medical Council, 2009. - Volume 2, part 1 - 568 pp.; Part 2 - 560 s.

Content

Rh conflict entails serious health problems for the unborn baby, so it is necessary to respond in a timely manner to the presence of such a pathology. Administration of the drug during pregnancy increases the chances of fetal viability and reduces the list of potential complications during the prenatal period. The pathology is serious, so the woman is under strict medical supervision when carrying a fetus.

What is Rh conflict during pregnancy?

If a woman has a negative Rh factor, she is at risk. This feature of the body does not have a negative impact on her health; problems arise during pregnancy. If the fetus has a positive Rh factor, an Rh conflict develops. This means that the mother's immune system recognizes the cells of the unborn child as foreign and begins to actively fight them.

A pregnant woman’s immunity produces immunoglobulin antibodies to such structures, which, penetrating the placental barrier, extensively destroy proteins that are not in the morphological composition of the mother’s blood. As a result, jaundice develops in newborns, associated with the breakdown of blood cells (hemolysis). More serious pathologies cannot be excluded, including hydrops fetalis, damage to the brain and heart, and stillbirth. To avoid such complications, the patient must be administered anti-Rhesus immunoglobulin during pregnancy.

When is anti-Rhesus immunoglobulin needed?

To give birth to a healthy child and eliminate Rh conflict, a specific protein is administered to pregnant women with a negative Rh factor. Among other medical indications for the administration of anti-Rhesus immunoglobulin in the absence of the Rh factor, doctors identify:

• spontaneous or intentional termination of pregnancy (abortion);
• abdominal trauma;
• threat of termination of pregnancy at any stage;
• after amniocentesis;
• placental abruption;
• pregnancy with subsequent birth of a child with a positive Rh factor;
• ectopic pregnancy.

How does anti-Rhesus immunoglobulin work?

This protein is isolated from the serum or plasma of donors who have been previously tested for the absence of antibodies to HIV, hepatitis B and C in the blood. When administered, the substance prevents the formation of antibodies to the Rh factor and prevents hemolysis of red blood cells in the fetus. At the discretion of the attending physician, anti-Rhesus immunoglobulin should be administered at the 28th obstetric week, but in this case the likelihood of mixing the two bloods increases significantly even before birth.

The optimal time to introduce protein is immediately after the baby is born. This is an effective prevention of hemolytic disease during the next pregnancy. If sensitization is detected (the presence of antibodies to the Rh factor in the blood of the expectant mother) and the Rh factor is positive, the use of anti-Rh immunoglobulin is strictly contraindicated and is not urgently necessary.

Instructions for use of anti-Rhesus immunoglobulin

A single dosage of this medication is determined individually; intravenous administration of serum is completely excluded. The detailed instructions for use contain the following valuable information for patients at risk:

1. The serum should be administered intramuscularly; self-medication is strictly contraindicated.
2. Before administering the drug, it is necessary to keep it at room temperature for at least 2 hours (warm under natural conditions).
3. To enter the medicine into the body, it is necessary to use a disposable sterile syringe with a wide bore.
4. When performing an operation to terminate a pregnancy, the serum must be administered immediately after its completion.
5. In the prenatal period, the recommended dose must be taken at the 28th obstetric week - once, then immediately after birth.
6. A single dose after successful delivery is 300 or 600 mcg of serum, and it should enter the body of the new mother in the first 48-72 hours.

Contraindications and side effects

This medication completely eliminates the risk of drug interactions, so it is allowed to be administered even during long-term antibiotic treatment. But after a single dose of immunoglobulin enters the female body, doctors do not rule out the occurrence of side effects. Among them:

• allergies, skin reactions, represented by urticaria, severe itching, burning, rashes and hyperemia of the skin, less often - acute anaphylactic shock;
• hyperthymia (instability of the nervous system, represented by unexpectedly high spirits, excessive activity in all areas of life);
• noticeable disorders of the digestive system, for example, severe signs of dyspepsia.

The introduction of this important component into the blood is not allowed for all women with a negative Rh factor. There are medical contraindications presented in the instructions as follows:

• hypersensitivity of the body to the active components of the administered drug;
• prevention of Rh conflict in newborns;
• diabetes mellitus in the expectant mother;
• identified sensitization (Rh antibodies detected in the blood).

Special instructions for the use of anti-Rhesus immunoglobulin

The serum cannot be used after the expiration date, non-compliance with the rules and conditions for storing the solution, or if the integrity of the bottle is damaged. Ideally, anti-Rhesus immunoglobulin is a colorless liquid, therefore, if the solution changes color and becomes cloudy, or a precipitate appears in the form of insoluble flakes, the bottle must be disposed of after opening. Vaccination is not possible because it can significantly harm the patient’s health. Other recommendations are presented below:

1. Immediately after vaccination, the patient should remain under strict medical supervision. It is possible that side effects may occur, which specialists can effectively manage with medication.
2. Within 30 minutes after the injection, an allergic reaction may occur directly at the injection site of the serum. The doctor’s task is to stop anaphylactic shock when it occurs.
3. Immunization with a “live” vaccine is carried out no earlier than 3 months after the administration of immunoglobulin.
4. If there is a Rh conflict between future parents, it is important to vaccinate when planning pregnancy. This helps increase the chances of having a healthy baby.
5. In the presence of an infectious process, it is advisable to undergo an injection of immunoglobulin.
6. Rh-positive parents or a father with a negative Rh factor do not need to administer serum.