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What is the risk of transfusing group O RhD-positive red blood cells to female service personnel of childbearing potential?
  1. Mark H Yazer1,
  2. T Scorer2,3,
  3. D McConnell4,5 and
  4. J Gluyas-Harris4
  1. 1Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2Centre for Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3Department of Haematology, University Hospitals Plymouth, Plymouth, UK
  4. 4Emergency Department, Derriford Hospital, Plymouth, UK
  5. 5Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Dr J Gluyas-Harris; jacob.gluyas{at}nhs.net

Abstract

The traditional approach to resuscitating injured women of childbearing potential (WCBP) with an unknown RhD type is to transfuse RhD-negative blood products. This is to prevent alloimmunisation to the RhD antigen and ultimately prevent haemolytic disease of the fetus and newborn (HDFN) in future pregnancies should she survive. RhD-negative blood products are scarce in both military and civilian blood stocks. It is likely that only RhD-positive blood products are available for a servicewoman injured in combat. This analysis will review the latest models of D-alloimmunisation following transfusion of RhD-positive blood products to injured WCBPs, the subsequent rates of adverse events from HDFN and describe some surveys of WCBPs’ preferences for transfusion in emergency situations. These data and opinions all point to the same conclusion: RhD-negative blood products should be the first choice for the resuscitation of women at risk of HDFN, but their absence should never lead to withholding a lifesaving transfusion.

  • blood bank & transfusion medicine
  • trauma management
  • accident & emergency medicine
  • military personnel
  • fetal medicine
  • maternal medicine

https://doi.org/10.1136/military-2024-002904

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    Footnotes

    • X @jgluyasharris

    • Contributors MY is the first author, contributing to the planning, literature search, analysis and writing of the manuscript. TS is the second author, contributing to the planning, literature search, analysis, review and editing of the manuscript. DM is the third author, contributing to the planning, literature search, literature analysis, review and editing of the manuscript. JGH is the fourth author, contributing to the planning, literature search, literature analysis and editing the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.