ABSTRACT
Background: Appropriate and timely administration of anti-D immunoglobulin (Ig) post-sensitizing events (PSE) and routine antenatal anti-D prophylaxis (RAADP) reduces the risk of developing immune anti-D resulting from pregnancy. Serious Hazards of Transfusion (SHOT), the UK haemovigilance scheme collects and analyses reports relating to failures in the management of anti-D Ig and RAADP. Delayed administration is defined as failure to give RAADP before 34 weeks gestation or anti-D Ig within 72 h for both (PSE), including delivery. COVID-19 pandemic has continued to affect the provision of safe and timely healthcare, including providing the optimal comprehensive care for pregnant women. Annual SHOT Reports have identified system failures resulting in omission/delays, administration errors, and other events involving anti-D Ig. This review looks at the impact of the COVID-19 pandemic on the provision of antenatal and postnatal care for patients requiring RAADP or anti-D Ig. Aims: To identify failures in the management of anti-D Ig and RAADP relating to the COVID-19 pandemic based on reports submitted to SHOT. Methods: The SHOT database was reviewed, reports relating to anti-D Ig and RAADP for 2021 were identified using the search terms' COVID' 'COVID-19' and 'pandemic'. Data were analysed for trends in errors relating to the COVID-19 pandemic. Results: A total of 341 reports were analysed by SHOT for 2021, the majority relating to omission or late administration (228/341, 66.9%). Twenty cases were identified where the COVID-19 pandemic was reported to be implicated;18 occurred in 2021, and two occurred in 2020. 16/20 involved omission or late administration of anti-D Ig or RAADP. In 1 case, anti-D Ig was given to a mother with a D-negative infant post-delivery, and in one case, RAADP was administered where the infant was predicted to be D-negative by cell-free fetal DNA analysis. One woman was given the wrong dose of anti-D Ig following a PSE, and in one case, a D-positive woman was inappropriately given anti-D Ig. The reported contribution of the pandemic to errors was variable. It included pregnant women being unable to attend clinics because they had COVID-19 or were self-isolating, clinics being cancelled to reduce attendances, changes to patient mixes in wards, misunderstanding of changes to policies relating to the use of anti-D Ig, cancellation of training and educational activities, staff redeployment and early discharge of patients to reduce the potential risk of exposure. Summary/Conclusions: Management of anti-D Ig and RAADP is a complex process involving many healthcare staff. Previous SHOT recommendations have included improvements to policies and processes, the introduction of checklists, and the administration of the product prior to discharge. The COVID-19 pandemic introduced new challenges for healthcare provision, with many changes being made to meet rapidly evolving situations. This review demonstrates that the effect of the pandemic contributed to errors involving anti-D Ig and RAADPmanagement, resulting in the potential for the development of immune anti-D and serious sequelae for subsequent pregnancies. The impact of change on safe practices must not be underestimated, and all measures must be taken to ensure patients are not adversely affected. Organizations should ensure that lessons learned from the pandemic are used to inform future practice and improve patient safety.