A study recently published in the American Journal of Perinatology offers suggestions for managing the current shortage of RhD immune globulin, which is often used to prevent hemolytic disease of the fetus and newborn (HDFN), in the United States. .
RhD immune globulin is administered to RhD-negative individuals during pregnancy or following a blood transfusion from an RhD-positive donor. This prevents the production of antibodies against the Rh factor, thereby preventing cases of HDFN during pregnancy.
Targeted RhD immune globulin administration refers to the use of non-invasive fetal testing to determine RhD status and therefore the need for immune globulin therapy. While several European countries have adopted this technique, the United States has not yet done so. Given the current shortage, this strategy could be highly effective in managing limited resources, the authors argue.
“By targeting RhD immune globulin administration solely to patients who need it, that is RhD negative patients with RhD positive fetuses, unnecessary treatment has been shown to be decreased by approximately 23-40%,” they wrote.
Read more about HDFN causes and risk factors
Furthermore, limiting RhD immune globulin administration to individuals experiencing first trimester pregnancy loss, particularly in cases with a low risk of alloimmunization, can help to conserve supplies.
The study also considered the cost-effectiveness of different approaches, finding that targeted RhD immune globulin was predicted to reduce medical expenses in the United Kingdom and Australia.
Given that the average price of one fetal RhD typing test in the United States is $300, though, targeted administration would be more costly than routine administration, the authors explained. The cost of testing would need to be drastically reduced in order for targeted administration to be cost-effective.
“We have a duty of care to ensure that RhD immune globulin is administered to those who will benefit most,” the study concluded.
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