RhoGAM and Clotting: What You Need to Know

When you're navigating the world of pregnancy, there's so much information to sift through. One important decision that may come up, especially if you’re Rh-negative, is whether or not to get Rho(D) immune globulin- the RhoGAM shot. If you've been told about RhoGAM, you're probably expecting to get the shot.

I recently had a client tell me she has increased microblood clotting issues related to long COVID and was worried about the shot- so here we go!

With clotting issues, your decision about the RhoGAM shot might feel even more complicated, so I am going to take us through the BRAIN acronym with the best info I can find. (You know if you’re my clients I’m here doing the research for you every step of the way…)

While RhoGAM is generally considered safe, it’s important to consider how a history with microclotting could impact your choice.

Let’s break it down using the BRAIN acronym:

B: Benefits
RhoGAM can prevent a condition called Rh incompatibility. This happens when an Rh-negative person is pregnant with an Rh-positive baby, leading to the production of antibodies that can harm your baby and future pregnancies. Basically, your body starts attacking the Rh+ blood as if it were a virus! By getting the RhoGAM shot during pregnancy and after delivery, you can protect both your current and future pregnancies from this issue.

Preventing Rh incompatibility remains a priority, especially since any complications during pregnancy could affect your health and the baby's. Even with clotting concerns, the shot offers the same protection, and your healthcare team will monitor you closely for any reactions.

R: Risks
Like any medical intervention, there are risks. Common side effects are usually mild, like swelling or soreness at the injection site. In rare cases, allergic reactions can occur. Blood clotting is also a risk associated with Rho(D) immune globulin (brand name: RhoGAM) - especially in people with history of heart disease, blood clots, and hardening of the arteries (atherosclerosis). I could find no research about RhoGAM and microclotting specifically!

It's always a good idea to chat with your provider about your personal health history to assess these risks in more detail. With a clotting condition, you’re probably already on high alert for anything that could trigger further complications.

While RhoGAM itself does not typically cause clotting, your medical team may want to evaluate your overall health, especially in the context of chronic diseases. Discuss any blood thinners or alternative treatments you're currently taking and whether RhoGAM could interact with those.

A: Alternatives
One alternative is not receiving RhoGAM, but this increases the chance that your body will produce antibodies, which can complicate future pregnancies. Another option is careful monitoring for antibody development with lots of blood tests, but that approach does not offer the same prevention benefits that RhoGAM does.

I: Intuition
If you feel uneasy or uncertain, it’s okay to ask more questions or take time to think. Usually the first shot occurs between 26-30 weeks gestation. You might feel peace of mind from the extra protection the shot offers with relatively very low risks. You might feel better about setting up a supportive plan for monitoring after the shot with your provider. Ask for what you need.

Your intuition is an important part of this decision.

N: Next Steps or Nothing
Next steps? The RhoGAM shot is typically given around 28 weeks and again after delivery if your baby is Rh-positive. You can also decide to do nothing, but this comes with the risk of sensitization, which will affect future pregnancies.

This is not the typical shot you get in your arm!

Usually, they give the RhoGAM shot in your buttock. (It's a large needle so it's a pretty painful one!) If your baby is found to be Rh+ on delivery, you'll get another shot within 72 hours postpartum. 

In Conclusion…

Managing chronic disease and pregnancy together is no easy task, but with the right information and a supportive medical team, you can make the best decision for you and your baby.

Ultimately, the decision about RhoGAM is yours. Take time to weigh the benefits and risks. Don’t hesitate to have another conversation with your healthcare provider if you need more clarity. Empower yourself to make the best choice for you and your baby!

If you do get the shot, tell your provider IMMEDIATELY if you have fever, back pain, nausea, vomiting, shaking, chills, changes in blood pressure (racing heart or lightheadedness), discolored urine, or blood in urine.

Some signs and symptoms of blood clots to look for include: redness, heat, swelling, point tenderness, or a discrepancy in diameter in the calves, chest pain, shortness of breath, severe headache, leg pain, or problems with vision, speech, or walking

Aitken SL, Tichy EM. Rh(O)D immune globulin products for prevention of alloimmunization during pregnancy. Am J Health Syst Pharm. 2015;72(4):267-276. doi:10.2146/ajhp140288

Fung-Kee-Fung K, Wong K, Walsh J, Hamel C, Clarke G. Guideline No. 448: Prevention of Rh D Alloimmunization. J Obstet Gynaecol Can. 2024;46(4):102449. doi:10.1016/j.jogc.2024.102449