Abstract
Background and ObjectivesD‐negative red cells are transfused to D‐negative females of childbearing potential (CBP) to prevent haemolytic disease of the foetus and newborn (HDFN). Transfusion of low‐titre group O whole blood (LTOWB) prehospital is gaining interest, to potentially improve clinical outcomes and for logistical benefits compared to standard of care. Enhanced donor selection requirements and reduced shelf‐life of LTOWB compared to red cells makes the provision of this product challenging.Materials and MethodsA universal policy change to the use of D‐positive LTOWB across England was modelled in terms of risk of three specific harms occurring: risk of haemolytic transfusion reaction now or in the future, and the risk of HDFN in future pregnancies for all recipients or D‐negative females of CBP.ResultsThe risk of any of the three harms occurring for all recipients was 1:14 × 103 transfusions (credibility interval [CI] 56 × 102–42 × 103) while for females of CBP it was 1:520 transfusions (CI 250–1700). The latter was dominated by HDFN risk, which would be expected to occur once every 5.7 years (CI 2.6–22.5). We estimated that a survival benefit of ≥1% using LTOWB would result in more life‐years gained than lost if D‐positive units were transfused exclusively. These risks would be lower, if D‐positive blood were only transfused when D‐negative units are unavailable.ConclusionThese data suggest that the risk of transfusing RhD‐positive blood is low in the prehospital setting and must be balanced against its potential benefits.
Highlights
UK guidelines recommend that for females of childbearing age, group O D-negative red blood cells (RBC) should be administered if blood group is unknown, to prevent D alloimmunization, which can lead to haemolytic disease of the foetus and newborn (HDFN) in future pregnancies [1]
Group O D-negative RBC are frequently transfused in the prehospital phase of resuscitation, as it is not possible to predict in advance if the patient is going to be a male or a woman of childbearing age or determine their D type
We modelled three specific harms: 1. Haemolytic transfusion reaction (HTR) associated with index transfusion of D-positive blood Major morbidity or mortality due to an HTR caused by pre-existing anti-D in the patient reacting with D-positive red cells that were transfused during haemorrhagic trauma resuscitation
Summary
UK guidelines recommend that for females of childbearing age, group O D-negative red blood cells (RBC) should be administered if blood group is unknown, to prevent D alloimmunization, which can lead to haemolytic disease of the foetus and newborn (HDFN) in future pregnancies [1]. In the last decade our improved understanding of the biology of acute traumatic coagulopathy has resulted in the development of damage control resuscitation [2,3,4,5], which advocates for the rapid and balanced administration of RBC, platelet and plasma as early as possible in the patient’s resuscitation. This has improved outcomes for patients compared to the standard of care alone, especially in the prehospital phase of the resuscitation [6,7,8,9]. Conclusion: These data suggest that the risk of transfusing RhD-positive blood is low in the prehospital setting and must be balanced against its potential benefits
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