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Re: Use of RhogamFrom: Ira Mark Bernstein (ibernste@moose.uvm.edu)Mon May 20 08:49:55 1996
Should the procedure be an early amnio (11-13 weeks'), >Microgam will suffice. However, not all centers advocate such an approach We use full dose rhogham at 11-13 weeks for the reasons recently cited on this list. When Rh immunoglobulin levels fall there may be a risk of enhancing rather then supressing maternal immune response. This was demonstrated by one of the early teams investigating the use of rhogham in their attempts to establish the appropriate dose (1). These types of reactions have been confirmed experimentally and sensitization is maximal when antigen-antibody complexes are provided with antigen in slight excess (2). For this reason we restrict the use of microgam for early abortions where there is no ongoing risk of exposure to antigen. For all ongoing pregnancies we use full dose rhogham and repeat it every 12-14 weeks until delivery. I should add that I am uncertain about the best interval between dosing. In 1990 Witter demonstrated that between 7 and 10 weeks after 300ug dosing, 90% of patients had no detectable titer (3). Nevertheless, we continue to dose q 12-14 weeks. 1. Pollack 1968 Transfusion 8:134 2. Terres, Wolins 1961 J Immunol 86:361 3. Witter 1990 AJOG 163:784 IRA
-- Ira M. Bernstein M.D. Department of OB\GYN University of Vermont (802) 656-5111 (ph) ibernste@moose.uvm.edu
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