Но в том же Бэй-Роу -Ди написано, что "In the case of a transfusion of Rho(D) positive red cells to an Rho(D) negative recipient, the volume of Rh positive whole blood administered is multiplied by the hematocrit of the donor unit giving the volume of red blood cells transfused. The volume of red blood cells is divided by 15 mL which provides the number of vials or syringes of BayRho-D Full Dose to be administered.
If the dose calculated results in a fraction, the next higher whole number of vials or syringes should be administered (e.g., if 1.4, give 2 vials or 2 syringes). BayRho-D Full Dose should be administered within 72 hours after an incompatible transfusion, but preferably as soon as possible. "
То есть принцип то один и тот же - попадание резус-положительной крови в резус-отрицательную. Так почему же при беременности это противопоказание?
А вот другие сслыки
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"Anti-D IgG is absolutely contraindicated only in those patients with a documented hypersensitivity to anti-D IgG.
In settings in which a fetomaternal hemorrhage can be calculated, 10 mcg of anti-D IgG should be administered for every milliliter of fetal blood in the maternal circulation. Thus, the 300-mcg dose is more than adequate for a typical fetomaternal hemorrhage and covers hemorrhage volumes of up to 30 mL of whole fetal blood. In the less than 1% of cases in which the volume of fetomaternal hemorrhage exceeds 30 mL, using the Kleihauer-Betke test to quantitate the volume of fetomaternal hemorrhage and administering the appropriate amount of anti-D IgG (ie, 10 mcg/mL fetal blood) is necessary.
Following delivery, if the infant is found to be Rh negative, the postpartum dose may be omitted. However, if any doubt remains concerning whether to administer anti-D IgG, always administer unless contraindicated. If the fetus if found to be Rh positive, administer anti-D IgG and take care to screen for excess fetomaternal hemorrhage, particularly if cesarean delivery or manual removal of the placenta occurred because both increase the risk and volume of fetomaternal hemorrhage. "
(то есть при возможном попадании крови плода в кровоток матери подсчитывается приблизительный объем и высчитывается доза ИГ, а при сомнение - вводить ИГ или нет лучше всегда вввести, если только нет гиперчувствительности к ИГ).
вот здесь
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и здесь
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исследования по вв введениею ИГ при тяжелой аллоиммунизации
CONCLUSION: A combination of PE and IVIG may be an efficient treatment possible to start in early pregnancy in patients with extremely severe Rh (D) alloimmunization, with a history of hydrops fetalis in previous pregnancies.
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про ИГ как препарат
If a large foeto-maternal haemorrhage (greater than 4 ml (0.7% - 0.8% of women)) is suspected, e.g., in the event of foetal anaemia or intrauterine foetal death, its extent should be determined by a suitable method, e.g., Kleihauer-Betke test, and additional doses of anti-D should be administered as indicated (20 micrograms/100IU for each 1 ml of foetal red blood cells).
Contraindications
Hypersensitivity to any of the components.
The intramuscular injection is contraindicated in persons with severe thrombocytopenia or other disorders of haemostasis.
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