My pregnant daughter is Rh negative, as am I. Today she spent the entire day at the hospital, where they drew blood, manufactured Rhogam from it, and finally gave her the shot. She was also given Rhogam once in early pregnancy, when she was having a threatened miscarriage.
I had the shots, too, both during my pregnancies and after childbirth. But all of mine were just a quick thing at a regular office visit. I had no idea that Rhogam is made out of your own blood. My latest pregnancy was only ten years ago. Is this day-long adventure something new? Is Rhogam always made from your own blood? Did they just use some of the blood drawn from me to make enough for both shots?
My daughter is seeing the same OBGYN that I saw ten years ago, but she is on Medicaid whereas I had insurance. She also has PCOS, which they said was the reason they did (something I can’t remember now). Is this why it’s different for her?
Rhogam is manufactured by Ortho Clinical Diagnostics from human donors. Your daughter’s extended stay at the hospital was for some reason unrelated to the production of the shot. The last time I dispensed Rhogam, it was in a labeled glass syringe with a plunger and needle attached.
An Rh negative woman who is a candidate for Rhogam is typically given a dose at 28 weeks, and then another post-partum. The testing involved is blood type determination (A, B, AB or O) and Rh determination. The lab may also perform an antibody screen depending on the woman’s transfusion or pregnancy history and blood bank policy. Clinical labs do not have the resources, the expertise or FDA clearance to manufacture a Rhogam-like drug from any source. They are allowed by the FDA to dispense Rhogam after the appropriate approved tests are performed and the results indicate that the woman should receive Rhogam.
How weird. She says she was specifically told that she had to wait while they made the Rhogam out of her blood. That’s the only thing she was there for. She had already had bloodwork done at her doctor’s office at her first visit.
She was either misinformed or misunderstood. She most likely needed an in-hospital blood typing in order for the Rhogam to be released from the from the hospital’s blood bank.
I don’t think a nurse or a well educated, well qualified lab technician would intentionally misinform her, but I have heard less educated employees in my hospital say some pretty off the wall things.
(I once heard a nurses aid, who was transporting a postpartum patient to her waiting car on a cold day, tell the new mom to cover the baby’s face to protect it from the cold and to not let any menstruating women hold the baby as both of these actions would cause colic!)
Regardless of any previous testing, even on the same day, a blood bank will always perform their own testing on blood drawn by their own staff. Results from another lab are politely acknowledged but never accepted without in-house verification. I agree that she either misunderstood or was (grossly) misinformed as to the reason for her wait.
In case anyone doesn’t know what Rhogam (Rho(D) Immune Globulin) is/does, I’ll be patronizing and say a word or two (hundred).
When a woman’s red blood cells do not contain what is called the Rh antigen (i.e. the Rh antigen being one of many, many chemicals that may or may not be found on a red cell), she is termed ‘Rh negative’. If her fetus is also Rh negative, there is no danger that the mom will mistake its red blood cells as being foreign.
On the other hand, if the fetus’s red cells are Rh positive (i.e. they have the Rh antigen on them) and are thus different than the mother’s red cells, mom’s immune system perceives them as being foreign and will make antibodies against them. These antibodies cross the placenta into the fetus’s circulation and can break apart the “baby’s” red blood cells. If that happens to a significant extent, the fetus/baby can develop a profound anemia (lack of red blood cells) to the point of being lethal. In addition, and critically, the breakdown products of the antibody-attacked red blood cells are poisonous to the newborn baby’s brain and cause a severe form of cerebral palsy.
So, Rhogam is actually a preparation of other people’s antibodies against the Rh antigen. By giving such an antibody preparation to the mother, any Rh positive cells from the fetus that spill over into the mother’s bloodstream are quickly removed by the Rhogam antibodies. Hence, they are not able to survive and thence stimulate the mother’s immune system to make antibodies against them (i.e. against the Rh antigen). Bottom line, then, is that the fetus/baby is no longer at risk of mom’s antibodies destroying its red blood cells and the all consequences that can result.
ETA - the Rh antigen is probably better called the ‘D’ antigen (old habits die hard; I learned it as Rh)
This is a good summary of the theory. In reality the mixing of fetal blood with maternal blood typically doesn’t happen during a normal uncomplicated pregnancy until delivery. When this reaction occurs during childbirth that particular child will not be affected but any subsequent Rh+ fetuses will be at risk.
Thank you very much. It was very helpful. But this just leads to further questions: How did all this work before modern medicine? Did some women just have one child? That seems fairly rare, so I’m curious at to what exactly is going on.
Subsequent children who are also Rh neg would not have any problems. So it would just lead to some healthy normal children and some still born children.
You’ve probably heard or read lots of accounts of the old days where a woman had many stillbirths or babies who died very early. No doubt at least some of them were caused by situations like this. If an Rh neg woman married an Rh positive man, and if he were homozygous (not carrying a recessive gene for Rh neg), it would be entirely possible that her first child would be fine but that each successive fetus would be at more and more risk as she built up more antibodies.