Algorithm for RhD immune globulin shortage yields over 50 % dosage savings.

Area of Science:

• Obstetrics and Gynecology
• Immunology
• Healthcare Management

Background:

• RhD immune globulin (RhIG) prophylaxis is critical for RhD-negative individuals to prevent hemolytic disease of the fetus and newborn.
• Periods of RhIG shortage necessitate evidence-based strategies to optimize its administration and conserve supply.
• Existing RhIG administration guidelines may not fully account for resource limitations or emerging diagnostic technologies.

Purpose of the Study:

• To develop and evaluate an evidence-based algorithm for RhIG administration in RhD-negative pregnant and postpartum individuals.
• To quantify the potential RhIG dosage savings achievable through the implementation of this algorithm.
• To assess the algorithm's impact on RhIG reserves during periods of shortage.

Main Methods:

• A quality improvement study was conducted within a large metropolitan health system.
• All RhIG dosages administered in inpatient and outpatient settings during 2023 were analyzed.
• The developed algorithm was applied retrospectively to 2023 RhIG administration data to calculate potential dosage savings.

Main Results:

• Implementation of the algorithm is estimated to yield over 50% RhIG dosage savings.
• Specific scenarios showed significant savings: up to 85% in the first trimester by omitting RhIG for early abortions, 39% in the second and third trimesters by incorporating non-invasive prenatal screening for fetal RhD status, and 50% for postpartum individuals with a 150 µg (750 IU) dose.
• The algorithm effectively targets RhIG administration, reducing unnecessary usage.

Conclusions:

• The developed algorithm provides a practical framework for optimizing RhIG use in healthcare systems.
• It enables maintenance of RhIG reserves during shortages without compromising patient safety.
• This strategy supports efficient resource allocation in obstetric care.