The current landscape of hemolytic disease of the fetus and newborn (HDFN), with emphasis on the status of RhD prophylaxis with Rh immunoglobulin (RHIG), has been reviewed at length in a study recently published in Transfusion Clinique et Biologique. The study included information about the use of RHIG in China, as it differs from many other regions.
According to the study, RHIG has been a therapeutic alternative for HDFN for over 50 years; since its introduction in 1968, the incidence of HDFN-associated deaths has sunk below 0.2% in the United States. Currently, most countries recommend RHIG administration in RH-negative women at 28 weeks of gestation and within 72 hours after birth to prevent the formation of antibodies capable of destroying fetal red blood cells, producing HDFN and its associated complications.
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The development of maternal antibodies directed against the Rh antigen can occur in any situation in which fetal blood enters in contact with maternal blood. Therefore, RHIG administration is also required before and/or after procedures such as intrauterine surgery, amniocentesis and miscarriages.
However, RHIG is not routinely used in China due to its limited availability in the country. In many cases, it must be administered abroad or in the district of Hong Kong. Due to its restricted use, there are no official guidelines regarding its dosing and administration.
“However, in recent years, policies for two or even three children in China have been liberalized, leading to an increasing demand for anti-D-Ig among D-negative pregnant women,” the authors wrote.
Epidemiological research shows that HDFN is frequent in China, with the majority of cases being caused by Rh incompatibility. The authors recommend clear labeling of mothers as Rh-positive or negative during prenatal care, confirmation of fetal Rh status through non-invasive methods in Rh-negative mothers and the timely administration of RHIG when necessary.
“This paper calls for a quick process to solve the problem of listing as soon as possible, so that the drug can be routinely used in public hospitals and included in medical insurance, so that more women and children in need of help can benefit,” the authors concluded.
