A survey on the use of Rh immune globulin during a nationwide shortage

Background: Rh immune globulin (RhIG) is used to prevent D alloimmunization and reduce the risk of hemolytic disease of the fetus and newborn (HDFN). Its use has been expanded to include immunoprophylaxis after D-incompatible transfusions. In the United States, a protracted RhIG shortage began in 2023. The AABB (Association for the Advancement of Blood & Biotherapies) Clinical Hemotherapy Subsection created a survey to assess RhIG usage patterns during this shortage. Methods: A survey was developed and electronically distributed to AABB-accredited institutions. The number of responses was tallied. Frequencies were calculated, and free text comments were categorized. Results: A total of 112 responses (13.7%) were received from all regions of the United States. While 6.2% (6/97) of respondents noticed increased RhIG usage, 70.0% (56/80) experienced a shortage of RhIG. The most common indication reported for RhIG use was D-negative pregnant patients carrying a D-unknown or D-positive fetus/neonate. Some respondents also permitted RhIG use in D-negative adult males and females outside of childbearing age following D-incompatible transfusion. The most common institutional responses to the shortage were to: formally monitor RhIG inventory (n = 37), add (n = 34)/switch (n = 24) manufacturers, and redistribute RhIG between facilities (n = 22). Few respondents (n = 7) limited or discontinued RhIG use in non-obstetric patients. Conclusions: While the majority of survey respondents were affected by the RhIG shortage, transfusion services still allowed RhIG to be issued outside of obstetric care. Given that RhIG is a limited resource and its intended goal is to reduce anti-D HDFN, more effective management of RhIG utilization is needed.