During the COVID-19 pandemic, supply challenges with respect to Rhesus (Rh)-negative packed red blood cells (pRBCs) were reported. However, a majority of institutional policies and personal practices on providing RhD-positive pRBCs to RhD-negative patients, who are at increased risk for hemolytic disease of the fetus and newborn (HDFN), did not change during this time.
This finding, which was published recently in the American Journal of Clinical Pathology, is based on the results of a survey distributed to physician members of the Association for the Advancement of Blood & Biotherapies (AABB).
The authors of the study sought to determine whether practices and policies on the allocation of RhD-positive pRBCs to RhD-negative patients changed or remained the same during the pandemic.
Survey reveals treatment methods largely remained the same
The questionnaire was designed by a workgroup in the AABB Clinical Hematology Subsection in an effort to obtain data on the effect of COVID-19 on pRBC policies and practices during the pandemic. The survey comprised a total of 17 questions, with seven of the questions related to demographics, five questions on institutional policies and five questions on personal criteria (in other words, “practice” questions). Survey participants were given an estimated total time of five minutes to complete the survey.
Read more about the testing and diagnosis of HDFN
Among 799 respondents, a total of 209 individuals participated in the survey and 104 responded to all of the questions, thus yielding a complete response rate of 13.02%.
Results of the survey listed the top three situations in which an RhD-negative patient would receive RhD-positive pRBCs as the following:
- RhD-negative female patients who were not of childbearing potential based on their age (20.67% prior to the pandemic and 21.61% during the pandemic)
- Male adults older than 18 years of age (18.43% prior to the pandemic and 17.59% during the pandemic)
- Patients older than 18 years of age who were not of childbearing potential and who experienced a massive hemorrhage (17.75% prior to the pandemic and 18.84% during the pandemic)
Overall, 83.7% of the institutional policies and 79.37% of the personal practices regarding the selection of pRBCs did not change during the pandemic. In fact, the habit of switching back to the administration of RhD-negative pRBCs following the administration of RhD-positive pRBCs varied. In all, 53.85% of the survey respondents noted that they had offered Rh immunoglobulin to any RhD-negative patients who had received RhD-positive pRBCs.
Findings from this survey were “likely because of the highly immunogenic nature of the D antigen and reluctance to accept the future risks of hemolytic transfusion reactions and HDFN,” the authors explained. “Another possible reason why changes did not occur, at the time of the study, is that transfusion services did not have the capacity to implement changes to their policies or procedures [because of] competing priorities and challenges, including staffing and constraints during a tumultuous time,” they concluded.
