Pathology Consultation on Patients With a Large Rh Immune Globulin Dose Requirement.
OBJECTIVE
To review the differential diagnosis and laboratory issues for women with a large calculated dose of Rh immune globulin (RhIG).


METHODS
A case-based approach is used to review the differential diagnosis of patients with a large calculated dose of RhIG, RhIG dosing for women with baseline elevations in hemoglobin F, the formulations of RhIG, and issues for the transfusion medicine service with the release of large doses of RhIG.


RESULTS
A large fetomaternal bleed after delivery requiring multiple doses of RhIG is rare. Such patients may require intravenous RhIG to avoid multiple injections. Patients with a large percentage of circulating fetal RBCs should be evaluated for a disorder of hemoglobin synthesis and, if present, should have quantification of the circulating fetal RBCs by flow cytometry.


CONCLUSIONS
Accurate laboratory evaluation of women with large fetomaternal bleeds is essential for appropriate RhIG administration.
From the Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston.
Kerry J
KJ
Welsh
From the Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston. Yu.Bai@uth.tmc.edu.
Yu
Y
Bai
D000328:Adult; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy; D011247:Pregnancy; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage*
D018029:Rho(D) Immune Globulin
Fetal-maternal hemorrhage; Hemoglobin disorders; Rh immune globulin