Major haemorrhage: putting evidence into practice

Primum, non nocere: Whole blood, prehospital transfusion and anti‐D hemolytic disease of the fetus and newborn

“…12 As with WB, at this time, there does not seem to be adequate evidence to support the general use of pre-hospital transfusion as a standard of care. 35 Similar to clotting factors and platelets, we do not need "normal" levels of red cells, and transfused products are not the same as what is circulating in vivo. As was shown by Weiskopf et al, humans can tolerate large volume acute blood loss if volume is replaced.…”

“…The estimated perinatal survival rate was 83.2% (95% confidence interval (CI) = 79. 35 This meta-analysis represents the most comprehensive study of the perinatal outcomes of RBC alloimmunized pregnancies that underwent IUT. 59 There was a high level of neonatal morbidity, a significantly lower gestational age at birth, and a considerable rate of complications that, altogether have a significant impact and burden on our healthcare system.…”

“…Due to the scarcity of ONEG RBCs, prehospital resuscitation protocols may involve the use of only OPOS WB or OPOS RBCs +/− plasma depending on the transportation method (helicopter vs. ambulance) and blood supplier 12 . As with WB, at this time, there does not seem to be adequate evidence to support the general use of pre‐hospital transfusion as a standard of care 35 …”