Abstract
Objective
The global shortage of RhD immune globulin, formally acknowledged by the Food and
Drug Administration in 2023, is ongoing but has improved in recent months. In response,
the American College of Obstetricians and Gynecologists (ACOG) issued guidance in
March 2024 on alternative strategies to conserve RhD immune globulin supplies. Our
objective is to evaluate strategies for optimizing RhD immune globulin use in pregnancy
amidst a global shortage.
Study Design
This clinical opinion reviews guidance on strategies to conserve RhD immune globulin.
These include targeted administration based on non-invasive fetal RhD genotyping using
cell-free DNA (cfDNA), the use of alternative RhD immune globulin products, and selective
withholding of prophylaxis in early pregnancy loss under 12 weeks' gestation. ACOG
guidance on the administration of RhD immune globulin in pregnancy differs from many
countries worldwide, as well as the World Health Organization and the American Society
of Family Planning.
Results
Targeted administration and the use of non-invasive cell-free DNA (cfDNA) testing
for fetal RhD status have shown promising accuracy and reliability in studies across
multiple countries, leading to reduced unnecessary prophylaxis and potential cost
savings. Additionally, withholding RhD immune globulin in select early pregnancy losses
could further conserve resources without increasing alloimmunization risk.
Conclusion
This review underscores the need for evidence-based approaches to manage limited RhD
immune globulin supplies effectively and suggests that targeted prophylaxis could
benefit both patient outcomes and healthcare resource allocation in the face of global
shortages.
Key Points
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Alternative RhD immune globulin strategies are vital amid ongoing global shortages.
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Targeted administration using cfDNA testing reduces unnecessary RhD immune globulin
use.
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Consider withholding RhD immune globulin in <12-week pregnancy loss without instrumentation.
Keywords
rhogam - RhD immune globulin - rhesus negative - cfDNA - hemolytic disease of the
fetus - alloimmunization - fetal antigen
