Attitudes of American adult women toward accepting RhD‐mismatched transfusions in bleeding emergencies

Abstract

Background There is an increasing literature demonstrating the benefits of prehospital and early in‐hospital transfusions. RhD‐positive products might only be available during these phases, which could pose consequences for future pregnancies if D‐alloimmunization occurs. This survey measured the willingness of females to accept urgent but incompatible transfusions in light of the potential for future pregnancy complications. Methods A survey was designed to assess the willingness of females ≥18 years of age to accept urgent incompatible transfusions when different absolute risk reductions in maternal mortality were presented along with a static rate of 0.3%–4.0% risk of harm to future pregnancies. The survey was sent electronically to women who are part of the Washington University Research Enhancement Core database. Results A total of 4896 delivered survey email invitations were distributed and 325 (6.6%) responses were received; 16 responses were excluded leaving 309 responses for analysis. Most of the responding women were White, college‐educated, and lived in Missouri. At least 90% of the respondents would accept an urgent incompatible transfusion when the absolute risk reduction in maternal mortality was ≥4%. Women without a college degree, who lived in Illinois, who were not able to have children appeared to be less willing than their counterparts to receive an incompatible transfusion when the absolute risk reduction in maternal mortality was low. Conclusion This survey demonstrated that adult women are highly likely to be open to accept urgent incompatible blood transfusions during a bleeding emergency when the absolute risk reduction in maternal mortality was ≥4%.

The females have spoken. A patient-centered national survey on the administration of emergent transfusions with the potential for future fetal harm

“…Our findings echo and expand those in both our previous pilot survey, as well as other studies that suggest that both patients and providers believe that the benefits of emergency lifesaving transfusion outweigh the small risk of future complications. 21 Yu et al 25 surveyed adult females and found that >90% would accept an emergency transfusion of potentially incompatible blood when the risk of fetal mortality from HDFN was <4%. Similarly, Kolodziej et al 26 found in a survey of transfusion directors and pediatric trauma medical directors that a majority would emergently transfuse type group O RhD-positive whole blood to children, although fewer supported transfusion of RhD-positive LTOWB of female children compared with male children.…”

Resuscitative practices and the use of low-titer group O whole blood in pediatric trauma

“…In another study of 300 female adults, at least 90% of the respondents would accept an urgent incompatible transfusion when the absolute risk reduction in maternal mortality was ≥4%. 77 Two additional surveys that solicit the opinion of parents and adolescent females are ongoing. Survey studies involving key stakeholder's opinions on pediatric blood product transfusion practices, specifically regarding the use of RhD+ LTOWB for female children in hemorrhagic shock whose RhD type is not known, are currently underway.…”

“…The proportion of acceptance was inversely related to the risk presented. In another study of 300 female adults, at least 90% of the respondents would accept an urgent incompatible transfusion when the absolute risk reduction in maternal mortality was ≥4% 77 . Two additional surveys that solicit the opinion of parents and adolescent females are ongoing.…”

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

“…Multiple surveys have been performed to incorporate the patients’ view of the risk/benefit assessment of using RhD+ LTOWB for life threatening bleeding. When presented with a 0% to 6% risk of HDFN and a 2% to 4% improvement in survival with use of LTOWB, women, their partners, and parents of young girls overwhelmingly state they would accept RhD+ LTOWB 49,52 . Input from key stakeholders to include patient or family advocates, as well as randomized control trial level evidence to assess the impact of LTOWB will further inform these challenging decisions.…”