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

OBJECTIVES: Our institution developed an evidence-based algorithm to guide administration of RhD immune globulin (RhIG) to RhD-negative pregnant and postpartum people in periods of shortage. This study aims to quantify potential RhIG dosage savings with implementation of this algorithm. METHODS: This was a quality improvement study that incorporated all dosages of RhIG administered in the inpatient and outpatient settings of a large metropolitan health system in 2023. We calculated potential dosage savings by applying the algorithm to the 2023 RhIG data. RESULTS: We estimated that implementation of this algorithm would result in a greater than 50 % RhIG dosage savings. Omitting RhIG for threatened, spontaneous, or induced abortion prior to 12 weeks gestation could result in up to 85 % dosage savings in the first trimester; incorporating non-invasive prenatal screening for fetal RhD status into clinical care would lead to a 39 % dosage savings in the second and third trimesters; and administering 150 µg (750 IU) RhIG to postpartum people would save 50 % of postpartum dosages. CONCLUSIONS: This algorithm can help healthcare systems maintain RhIG reserves during shortages while balancing patient safety.