Considering <i>equality</i> in transfusion medicine practice

Yazer, Mark H.; Díaz‐Valdés, José R.; Triulzi, Darrell J.; Spinella, Philip C.; Emery, Stephen P.; Young, Pampee P.; Seheult, Jansen N.; Leeper, Christine M.; Jones, Jennifer M.; Andrew, P

doi:10.1111/bjh.18830

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…4). 50,51 While RhD-LTOWB avoids this risk entirely, it is in very short supply; only 6% of the population is able to donate RhD-LTOWB. In practice, some centers use RhD+ LTOWB in females of childbearing potential acknowledging this risk of HDFN, as well as the described benefits of LTOWB; of the 11 programs using LTOWB in pediatric patients, six of them will use RhD+ LTOWB if needed.…”

Section: Mtp Activation Teamsmentioning

confidence: 99%

Damage-control resuscitation in pediatric trauma: What you need to know

Russell

Leeper

Spinella

2023

J Trauma Acute Care Surg

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Damage-control resuscitation (DCR) consists of rapid control of bleeding, avoidance of hemodilution, acidosis, and hypothermia; early empiric balanced transfusions with red blood cells, plasma and platelets, or whole blood when available, and the use of intravenous or mechanical hemostatic adjuncts when indicated. The principles used in pediatric and adult trauma patients are quite similar. There are very important recognized physiologic differences in children with traumatic hemorrhagic shock that warrant slight variations in DCR. In pediatric trauma patients, early physiologic signs of shock may be different from adults and the early recognition of this is critical to enable prompt resuscitation and utilization of damage control principles. This review details the current principles of pediatric DCR based on the best available literature, expert consensus recommendations, and also describes a practical guide for implementation of DCR strategies for pediatric trauma patients.

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Section: Mtp Activation Teamsmentioning

confidence: 99%

Damage-control resuscitation in pediatric trauma: What you need to know

Russell

Leeper

Spinella

2023

J Trauma Acute Care Surg

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“…[9][10][11] There are myriad events that must occur between the time an injured WCP receives an RhD-positive RBC or LTOWB during her resuscitation and having a pregnancy affected by HDFN in the future. These events have been described elsewhere, [12][13][14] and they include a requirement that the woman actually be of childbearing age and potential, RhD-negative, survive the trauma, become Dalloimmunized, become pregnant with an RhD-positive fetus, and that the fetus experiences some degree of HDFN. Thus, even if the woman develops anti-D as a result of her transfusion during her resuscitation, several other events must still occur in order for a future fetus to be affected by HDFN.…”

Section: Introductionmentioning

confidence: 99%

Effect of major trauma on the expected number of births in Finnish women: A nationwide population‐based public data and register analysis

Vaajala,

Kuitunen,

Mattila

et al. 2024

Transfusion

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BackgroundThe effect of major trauma on subsequent fertility is poorly described. If women have lower fertility after trauma, they would have a lower risk of anti‐D mediated hemolytic disease of the fetus and newborn in a future pregnancy following the transfusion of RhD‐positive blood to RhD‐negative women during their resuscitation.Study Design and MethodsData was obtained from the Care Register for Health Care, National Medical Birth Register, and open access data from Statistic Finland to evaluate the effect of major trauma (traumatic brain injuries, spine, pelvic, hip/thigh fractures) on the age‐specific number of births during years 1998–2018. The total number of births before a specific maternal age for different trauma populations was calculated and these were compared to the corresponding number of births in the general population.ResultsThere were 50,923 injured women in this study. All injured women, including when analyzed by the nature of their injury, demonstrated lower expected numbers of births starting at approximately 28 years of age compared to the general population of women in Finland. At age 49, the expected number of births in the general population was approximately 1.8, whereas for all injured women 0.6, women with TBIs and spine fractures 0.6, women with pelvic fractures 0.5, and women with hip or thigh fractures 0.3.DiscussionInjured women are predicted to have lower fertility rates compared to the general population of Finnish women. The lower fertility rate should be considered when planning a blood product resuscitation strategy for injured women.

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“…See text for explanation of the probabilities listed next to each event. Modified and reprinted from reference 6 with the kind permission of John Wiley and Sons.…”

Section: Introductionmentioning

confidence: 99%

Another piece of the hemolytic disease of the fetus and newborn puzzle after RhD-positive transfusion in trauma resuscitation: the proportion of pregnant women who produce high titer anti-D

Yazer,

Emery,

Triulzi

et al. 2024

Trauma Surg Acute Care Open

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BackgroundAfter the transfusion of RhD-positive red blood cell (RBC)-containing products to an RhD-negative woman of childbearing potential (WCP) during trauma resuscitation, there are several events that must occur for that WCP to have a future pregnancy affected by hemolytic disease of the fetus and newborn (HDFN). This study identified and quantitated the frequency of a novel event in the sequence from RhD-positive transfusion during trauma resuscitation to an HDFN outcome, that is, the development of a high titer anti-D among women who were D-alloimmunized.MethodsThe transfusion service records at one maternity hospital were searched to locate all anti-D titers that had been performed on pregnant women between 1996 and 2022. The highest titer score during each pregnancy was recorded for this study. The critical titer threshold at this institution was ≥16. Passive anti-D caused by Rh immunoglobulin were excluded from analysis.ResultsThere were 97 pregnancies in 85 patients who had an immune-stimulated anti-D; in 60 of 97 (62%) pregnancies, the highest titer score was ≥16. There were 12 patients who had titers performed in two pregnancies during the study period; the correlation between the maximum titer in each pregnancy was not statistically significant (Spearman rank correlation r=0.42, p=0.17).ConclusionIn this single center study, 62% of D-alloimmunized pregnant women had a high titer antibody. When considering all of the events that must occur for HDFN to happen, the rate of perinatal mortality was calculated to be 0.04% and the rate of perinatal death or serious adverse event from HDFN was 0.24%.

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Considering equality in transfusion medicine practice

Cited by 4 publications

References 14 publications

Damage-control resuscitation in pediatric trauma: What you need to know

Damage-control resuscitation in pediatric trauma: What you need to know

Effect of major trauma on the expected number of births in Finnish women: A nationwide population‐based public data and register analysis

Another piece of the hemolytic disease of the fetus and newborn puzzle after RhD-positive transfusion in trauma resuscitation: the proportion of pregnant women who produce high titer anti-D

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