RhoGAM and Coombs - page 2

I'm a nursing student and we just took our OB final this morning. There was a question on the test that I'm confused by and I was hoping someone might be able to explain. Let me preface by... Read More

  1. Visit  cnovice profile page
    2
    In refrence to your question : Rho-GAM is a blood product given to,
    • RH(-) moms delivering an RH(+) baby.
    A type and antibody test is done on all moms early in pregnancy and if indicated at 28wks she may recieve Rho-GAM. Later on at delivery a blood sample is taken from the infants umbilical cord (this is called cord blood) and the test done with this blood is called a coombs test. If this coombs test is positive and mom is RH(-), Rho-GAM will be given within 72 hours of delivery.
    • Rho-GAM prevents an antibody response in mom and also prevents hemolytic disease of the newborn in the mom's future pregnancy
    • Rho- GAM is given in the deltiod muscle to the mom.
    Hope this is helpful.
    k7redeemed and Sarah K, RN like this.
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  3. Visit  RNmommy profile page
    0
    Rh and Coombs are separate and different. The Coombs tests will be part of a rhogam work up for an Rh neg mom after baby's blood type comes back Rh positive.

    Also please note that coombs testing done on babies born to all type O mothers is testing for ABO incompatibility and is not related to Rh status and has no bearing on whether or not mom gets rhogam.

    Rh isoimmunization is a problem for mom, ABO incompatibility is a problem for baby.

    ITA with Jolie. Your PP notes are correct. Rhogam would only be indicated when the coombs are both neg, indicating no isoimunization.

    Many women do not receive adequate prenatal care and therefore it cannot be assumed that every Rh negative mother received a dose of Rhogam at 28 weeks.
    Last edit by RNmommy on Mar 2, '08
  4. Visit  RNmommy profile page
    0
    Quote from cnovice
    Later on at delivery a blood sample is taken from the infants umbilical cord (this is called cord blood) and the test done with this blood is called a coombs test. If this coombs test is positive and mom is RH(-), Rho-GAM will be given within 72 hours of delivery.
    That is not correct. The direct coombs on the cord blood will indicate only ABO incompatibility in the baby. The blood type will indicate the need for rhogam for mom.

    The question in the OP is referring to coombs testing on the mother and it's indication for rhogam administration.
  5. Visit  RainDreamer profile page
    1
    I don't see where a Coombs test would have any bearing on whether or not a mother gets Rhogam or not, as it would be of no help by that point, just as Jolie pointed out.

    I've actually been learning a lot about this very thing lately because my little primary at work was born to a mother that didn't get Rhogam after her first miscarriage because she is from another country and for some reason they didn't give it over there. Therefore the mom was already sensitized ..... made for a very sick baby.
    Elvish likes this.
  6. Visit  RNmommy profile page
    0
    Quote from RainDreamer
    I don't see where a Coombs test would have any bearing on whether or not a mother gets Rhogam or not, as it would be of no help by that point, just as Jolie pointed out.
    It would be pointless to give a mom with a positive direct and indirect Coombs rhogam, as isoimmunization has already occurred. However, rhogam IS indicated when an Rh neg AND coombs negative mom gives birth to an Rh pos baby to protect her FUTURE babies from hemolytic anemia.
  7. Visit  RainDreamer profile page
    0
    Quote from RNmommy
    It would be pointless to give a mom with a positive direct and indirect Coombs rhogam, as isoimmunization has already occurred. However, rhogam IS indicated when an Rh neg AND coombs negative mom gives birth to an Rh pos baby to protect her FUTURE babies from hemolytic anemia.
    Correct.
  8. Visit  motyandproudofit profile page
    0
    Can someone explain what blood type has to do with Rh. I totally understand that if the mother is Rh- and baby is Rh+ then mother needs Rhogam but every once in awhile I read things about Type O blood and I have no idea what blood type has to do with it.
  9. Visit  Apgar10 profile page
    0
    Are the Rh- mothers getting the Coombs workups in their labs when they are admitted to L&D? Or is this just academic in discussion?
  10. Visit  NurseNora profile page
    3
    Quote from motyandproudofit
    Can someone explain what blood type has to do with Rh. I totally understand that if the mother is Rh- and baby is Rh+ then mother needs Rhogam but every once in awhile I read things about Type O blood and I have no idea what blood type has to do with it.
    Blood type O has no antigen in it to cause a reaction in a recipeint, that is why O is the universal donor. Type A has A antigens and type B has B antigens and type AB has both A and B antigens. That's why type O can only receive blood from an O donor. The antigens in the other 3 types would cause an O recipient to form antibodies that would break down A, B or AB cells.

    If a pregnant woman is type O and has a baby that's type A, the inevitable small amount of mixing of blood could cause her to form antibodies against type A blood, so that a subsequent type A baby would have it's blood cells attacked by mom's anti A antibodies. It works the same way Rh does, just against a different part of the blood type. There is nothing like RhoGam for sensitized Type O moms. Fortunately, ABO incompatability is usually not as severe as Rh sensitization. But that is why many docs do a Type and Coombs on babies of Type O moms. Even if the Coombs is negative, showing the baby's blood has not been broken down in utero by mom's antibodies, these babies are more likely to become jundiced and to require billi lights. Just something for you to be aware to be especially alert for in your babies of Type O moms.
    iteachob, SmilingBluEyes, and Elvish like this.
  11. Visit  motyandproudofit profile page
    0
    Just academically speaking, thanks.
  12. Visit  SmilingBluEyes profile page
    0
    RhoGAM is only effective given in the case whereby a mom is RH neg and baby is RH positive (in the case of live birth) and when it is given within 72 hours of a live birth, , still birth, induced abortion or miscarriage. COOMBS testing is separate and RhoGAM treatment is not treatment for this problem. You are looking for marked jaundice and will be treating that however.
  13. Visit  JesLeigh profile page
    0
    Hey guys. I am studying for my ob hesi and I thought I would let you know that my hesi review book states that if a mother has a positive coombs test that she does not need rhogam. This is because she is already sensitized. PG. 269, Hesi review book if you guys have the book as well.
  14. Visit  dinogwapo profile page
    0
    this is my answer

    Rh (D) immune globulin (RhoGAM) is given only if antibody formation has not occured.
    a negative Coomb's test confirms that antibodies have not been formed. the shot is als recommended within
    72 hours after birth, miscarriage, abortion, ectopic pregnancy, or amniocenteses.

    Rh - immune globulin contains antibodies to the Ph factor. these antibodies seek out the baby's Rh+ blood in the mother's bloodstream, attach to it, and destroy it before the mother can make antibodies of her own. Rh-immune globulin's protective effect last for about 12 weeks, so the shot will be given again during future pregnancies.


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