AM24-MN-10-O: Should Rh Immune Globulin Be Administered After First Trimester Bleeding Events? (Enduring)

AABB Standards 5.30.2, 5.30.3, and 5.30.4 require that Rh negative women who are pregnant or who have been pregnant recently be considered for Rh Immune Globulin administration when the Rh type of the fetus/neonate is unknown or positive when tested for D or weak D. Further, these Standards require a process to ensure that an adequate dose of Rh Immune Globulin is administered as soon as possible after exposure. In juxtaposition to these Standards, some recent literature has suggested that fetal red blood cell (RBC) exposure in first trimester bleeding events may be below a threshold for maternal Rh sensitization, thus making Rh Immune Globulin administration unnecessary. Since 2020, many professional medical organizations, including the World Health Organization (WHO), have changed their recommendations regarding the use of Rh Immune Globulin for first trimester bleeding events. The goal of this session is to present perspectives on the need to administer Rh Immune Globulin after first trimester bleeding events. The session will begin by describing some historical highlights of the use of Rh Immune Globulin, the impact of Rh Immune Globulin on the incidence of Hemolytic Disease of the Fetus and Newborn (HDFN), and the risk profile of both Rh Immune Globulin administration and non-administration. Second, recent literature regarding first trimester bleeding events and the arguments for and against Rh Immune Globulin administration will be discussed. Both established and evolving American and international society guidelines will also be reviewed. As Rh Immune Globulin is a crowning achievement and mainstay of modern transfusion medicine, this session is sure to provide a lively discussion about an important topic.