It is time to reconsider the risks of transfusing RhD negative females of childbearing potential with RhD positive red blood cells in bleeding emergencies

Rate of RhD-alloimmunization after the transfusion of RhD-positive red blood cell containing products among injured patients of childbearing age: single center experience and narrative literature review

“…It is also important to keep the 42.7% alloimmunization rate in the context of all of the events that have to occur for a transfused RhD-negative FCP to have a pregnancy that is affected by severe HDFN. The overall rate of fetal demise occurring in an RhD-negative FCP who received an RhD-positive transfusion and survived her trauma, became alloimmunized, and then carried an RhD-positive fetus was calculated to be 0.3% [18], largely because of the excellent HDFN diagnosis and treatment modalities available in some academic centers [19]. The rate of 0.3% was calculated using an RhD-alloimmunization rate of 21%, which was derived by combining the results of three of the larger studies on RhD-alloimmunization.…”

Conservation of Rh negative Low Titer O Whole Blood (LTOWB) and the need for a national conversation to define its use in trauma transfusion protocols

“…There are likely two primary reasons transfusion services request O neg LTOWB: to treat FCP with unknown type and to treat pediatric patients. Several recent commentaries have suggested extending the use of O pos LTOWB and packed RBCs to FCPs to conserve this limited resource and minimize the occurrence of shortages that pose potential for serious immediate repercussions for recipients with anti‐D and other groups who require O neg RBCs 18,19 . The considerations discussed below are often used to advocate restricting hospital inventory and/or limiting LTOWB production to only O pos; however, the arguments are nuanced and evolving:…”

“…Despite the potential for many RBC antigens to cause clinically significant alloantibody and/or hemolytic disease of the newborn (HDN), the standard transfusion practice in FCP is routinely driven solely based upon concern for anti‐D alloimmunization and risk of associated HDN. In a recent commentary, Yazer et al 19 suggest reconsideration of this conventional teaching and practice, using an updated risk assessment based upon modern‐day probabilities. They considered the following in their evaluation: the rate of survival in trauma with severe bleeding is approximately 76%; the rate of D alloimmunization in hospitalized Rh neg recipients is approximately 21%; the probability that an FCP will become pregnant is approximately 86%; the likelihood of a pregnant female carrying a D‐positive fetus is 60%; and the risk of fetal death in Rh HDN is approximately 4%.…”

How do I implement a whole blood–based blood preparedness program in a small rural hospital?

“…Given the low risk of alloimmunization, it could be considered to transfuse D-positive whole blood to D-negative (or D-unknown) women of childbearing age after waiver by the medical director. 51 After transfusion with more than 2 to 4 units of whole blood to a patient with blood type A, B, or AB, careful monitoring of levels of passively transfused anti-A and/or anti-B not native to the patient should be performed. If subsequent transfusions with RBCs are needed, group O RBCs should be given until passively transfused anti-A and/or anti-B is not detectable in the patient.…”

“…However, D‐negative blood products are limited under normal circumstances, and it may be difficult to supply sufficient quantities of the product. Given the low risk of alloimmunization, it could be considered to transfuse D‐positive whole blood to D‐negative (or D‐unknown) women of childbearing age after waiver by the medical director 51 …”