The risks and benefits associated with transfusion of the Rhesus (Rh)D type of low-titer O whole blood (LTOWB) in trauma situations with severe bleeding must be considered in the context of possible perinatal mortality linked to hemolytic disease of the fetus and newborn (HDFN), according to findings from a web-based survey conducted among blood bank directors/managers and published in the journal Transfusion.
Improved survival from the occurrence of traumatic hemorrhagic shock via transfusion of LTOWB or conventional component therapy that is administered in a balanced ratio has been reported in multiple studies. One obstacle associated with the use of LTOWB, however, is the low availability of RhD-negative LTOWB.
In the current analysis, the researchers sought to assess hospital policies in the United States with respect to choice of RhD-type blood products being utilized in emergency bleeding situations. Based on findings from the Association for the Advancement of Blood & Biotherapies (AABB) 2019 “Recommendations on the Use of Group O Red Blood Cells [RBCs],” it is suggested that “…significant efforts should be made to avoid transfusion of RhD-positive RBCs to females of childbearing potential (unless there is no alternative), as alloimmunization may cause . . . HDFN during future pregnancies.”
Variability in practice across the United States has been linked to increased approval regarding the use of RhD-positive blood products among all individuals at times of trauma resuscitation, along with the rising utilization of LTOWB during such events. The present survey was developed to clarify current practices at large US trauma centers about the blood products and RhD type administered to critically injured patients.
Read more about HDFN symptoms and risks
In the survey, data were obtained and managed from the blood bank administrators via use of Research Electronic Data Capture—a secure, web-based software platform that has been created in an effort to support the capture of data for research studies. A total of 157 US hospitals received an electronic version of the survey. An overall response rate of 64.3% was reported, with 101 of the 157 surveys returned. A 94.1% completion rate was reported, with 95 of the 101 survey responses confirmed and clarified.
Results of the study showed that of the 95 complete responses on which type of blood product is being used as the primary resuscitation method for massive bleeding, the responses were as follows:
- RBCs only: 40% (38 of 95) of the respondents
- Both RBCs and LTOWB: 49% (47 of 95) of the respondents
- LTOWB only: 11% (10 of 95) of the respondents
Based on these findings, 60% (57 of 95) of the respondents reported the use of LTOWB. Of the 60% of hospitals that use LTOWB for the treatment of massive bleeding, 67% (38 of 57) of them receive RhD-positive LTOWB only, whereas 32% (18 of 57) of them use both RhD-positive LTOWB and RhD-negative LTOWB, and 2% (1 of 57) of them use Rh-D negative LTOWB only.
In fact, at those places that issue LTOWB, RhD-negative LTOWB is used either exclusively or preferentially more frequently in adult females of childbearing potential (FCPs; 46%) and in pediatric FCPs (55%) than in men (4%) and in boys (24%). In contrast, RhD-positive LTOWB is utilized either exclusively or preferentially more often among men (94%) and among boys (54%) compared with adult FCPs (40%) or pediatric FCPs (21%).
At those hospitals that do administer LTOWB, use of the product is not allowed in 12% of FCPs, in 21.4% of pediatric FCPs, and in 17.1% of boys.
“The risk and benefits of LTOWB compared [with] the rare occurrence of . . . HDFN need further examination in the context of withholding a therapy for females that has the potential of improved outcomes,” the authors explained. “Counseling should be universally provided at institutions that administer RhD-positive blood products to RhD-type unknown or negative pediatric and adult FCPs,” they concluded.
