A survey recently published in Transfusion regarding the effects of the Rhesus immunoglobulin (RhIG) shortage in the United States found that medical institutions had to adjust to ensure equitable distribution among vulnerable patient populations.
RhIG is an integral part of the management of hemolytic disease of the fetus and newborn (HDFN).
Only a few manufacturers produce RhIG in the United States, and there are no alternative recombinant products. Intermittent shortages have occurred, with one of the longest periods on record starting from December 2023 and still persisting as of February 2025. As such, guidance has been issued encouraging physicians to strictly adhere to evidence-based guidelines to ensure that the existing supply of RhIG is used with discretion.
Researchers sought to identify if RhIG shortages have had an impact on those who require it. They identified 820 representatives from each Association for the Advancement of Blood and Biotherapies (AABB)-accredited blood bank/transfusion service in the United States; these individuals were invited to complete a survey assessing the impact of this shortage.
Read more about HDFN testing and diagnosis
In total, 112 individuals responded to the survey. Almost all patients were familiar with how their institution managed RhIG resources. 70% of respondents reported a shortage of RhIG at their facility, while 30% did not. A total of 6.2% of respondents reported an increase in RhIG usage, attributable to increased usage in emergency obstetrical services.
The most common reason for the issuing of RhIG (94 respondents) was for D-negative obstetric patients who do not have anti-D alloantibodies. Among the non-obstetric patient population, the most common reason for the issuing of RhIG was for D-negative female patients who were of childbearing age.
The survey also revealed different ways in which RhIG shortages were approached. The most common response was to monitor RhIG at regular intervals, followed by the addition of other RhIG manufacturers. Meanwhile, 24 institutions chose to switch RhIG manufacturers, while 22 redistributed RhIG between intra-network facilities.
“This survey provided insight into RhIG inventory management and utilization practices during the RhIG shortage in the United States that began in late 2023,” the authors of the study wrote. “Education and collaboration with institutional stakeholders are necessary to develop institutional guidelines that can be followed to optimize appropriate RhIG use and ensure it is available to D-negative obstetric patients to prevent anti-D HDFN whenever possible.”
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