Most mothers would agree to transfuse a female child with Rh-positive blood in the context of a life-threatening hemorrhage that requires an urgent transfusion, despite the risk of alloimmunization and the onset of hemolytic disease of the fetus and newborn (HDFN) during adulthood, according to a recently published study in Transfusion.
HDFN occurs as a consequence of D-alloimmunization, the process by which the immune system of a Rh-negative mother produces antibodies that target the Rh antigen of the fetus. In most cases, alloimmunization occurs after the first pregnancy, in which the maternal immune system enters contact with the blood of a Rh-positive baby. However, alloimmunization can also occur after a blood transfusion with Rh-positive blood.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell (RBC) disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy. Numerous antibodies to RBC antigens can be linked to HDFN, such as those from the ABO and Rh blood group systems.
To avoid D-alloimmunization and other complications associated with blood transfusions, O Rh-negative blood is the preferred blood type for emergency transfusions. However, O-negative blood is often in short supply and not available in all centers. Therefore, in certain cases, Rh-negative patients must receive h-positive blood to save their lives in emergency settings.
Learn more about HDFN causes and risk factors
“It is sometimes necessary to use RhD-positive LTOWB in instances where recipient’s RhD type is unknown, as their blood type often cannot be ascertained within the time necessary to initiate type-specific life saving transfusion,” the authors wrote.
The authors aimed to assess the opinion of mothers with a history of D-alloimmunization on the issue of female children receiving blood transfusions with Rh-positive blood in the context of life-threatening hemorrhage through a survey.
Over 100 mothers who met the criteria were included in the study. Results showed that most mothers would accept an Rh-positive transfusion in cases where it could improve their chance of survival by 4% or higher.
“Alloimmunized mothers would accept the risk of D-alloimmunization in a RhD-negative female child for improved survival in cases of life threatening bleeding,” the authors concluded.
