Not as “D”eadly as once thought – the risk of D-alloimmunization and hemolytic disease of the fetus and newborn following RhD-positive transfusion in trauma

Yazer, Mark H.; Panko, Gleb; Holcomb, John B.; Kaplan, Alesia; Leeper, Christine M.; Seheult, Jansen N.; Triulzi, Darrell J.; Spinella, Philip C.

doi:10.1080/16078454.2022.2161215

Cited by 19 publications

(26 citation statements)

References 29 publications

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“…Emergency transfusion of un-crossed blood group O is only indicated for vital risk [27 ▪ ]. The risk of D-alloimmunization following RhD-positive transfusion seems to be smaller than previously thought [30].…”

Section: Red Blood Cellsmentioning

confidence: 60%

Massive transfusion in trauma

Lier,

Hossfeld

2024

Current Opinion in Anaesthesiology

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Purpose of review The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion. Recent findings Severe trauma patients require massive transfusion, but consensual international definitions for traumatic hemorrhage shock and massive transfusion are missing. Current literature defines a massive transfusion as transfusion of a minimum of 3–4 packed red blood cells within 1 h. Using standard laboratory and/or viscoelastic tests, earliest diagnosis and treatment should focus on trauma-induced coagulopathy and substitution of substantiated deficiencies. Summary To initiate therapy immediately massive transfusion protocols are helpful focusing on early hemorrhage control using hemostatic dressing and tourniquets, correction of metabolic derangements to decrease coagulopathy and substitution according to viscoelastic assays and blood gases analysis with tranexamic acid, fibrinogen concentrate, red blood cells, plasma and platelets are recommended. Alternatively, the use of whole blood is possible. If needed, further support using prothrombin complex, factor XIII or desmopressin is suggested.

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Section: Red Blood Cellsmentioning

confidence: 60%

Massive transfusion in trauma

Lier,

Hossfeld

2024

Current Opinion in Anaesthesiology

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“…Rh-negative pregnant individuals may become sensitized and immunized through exposure to Rh-positive RBCs, with risk of sensitization depending on the volume of exposure, number of exposures, ABO compatibility, antigenic profile, immune status, and other factors . While one might surmise that elevated fRBC counts before abortion were due to a prior exposure, prior bleeding episodes were not found to be associated with elevated fRBC counts.…”

Section: Discussionmentioning

confidence: 99%

Induced Abortion and the Risk of Rh Sensitization

Horvath,

Huang,

Koelper

et al. 2023

JAMA

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ImportanceWhile population-level data suggest Rh immunoglobulin is unnecessary before 12 weeks’ gestation, clinical evidence is limited. Thus, guidelines vary, creating confusion surrounding risks and benefits of Rh testing and treatment. As abortion care in traditional clinical settings becomes harder to access, many people are choosing to self-manage and need to know if ancillary blood type testing is necessary.ObjectiveTo determine how frequently maternal exposure to fetal red blood cells (fRBCs) exceeds the most conservative published threshold for Rh sensitization in induced first-trimester abortion.Design, Setting, and ParticipantsMulticenter, observational, prospective cohort study using high-throughput flow cytometry to detect circulating fRBCs in paired maternal blood samples before and after induced first-trimester abortion (medication or procedural). Individuals undergoing induced first-trimester abortion before 12 weeks 0 days’ gestation were included. Paired blood samples were available from 506 participants who underwent either medical (n = 319 [63.0%]) or procedural (n = 187 [37.0%]) abortion.ExposureInduced first-trimester abortion.Main Outcomes and MeasuresThe primary outcome was the proportion of participants with fRBC counts above the sensitization threshold (125 fRBCs/5 million total RBCs) after induced first-trimester abortion.ResultsAmong the 506 participants, the mean (SD) age was 27.4 (5.5) years, 313 (61.9%) were Black, and 123 (24.3%) were White. Three of the 506 participants had elevated fRBC counts at baseline; 1 of these patients had an elevated fRBC count following the abortion (0.2% [95% CI, 0%-0.93%]). No other participants had elevated fRBC counts above the sensitization threshold after induced first-trimester abortion. The median change from baseline was 0 fRBCs, with upper 95th and 99th percentiles of 24 and 35.6 fRBCs, respectively. Although there was a strong association between the preabortion and postabortion fRBC counts, no other baseline characteristic was significantly associated with postabortion fRBC count.Conclusions and RelevanceInduced first-trimester abortion is not a risk factor for Rh sensitization, indicating that Rh testing and treatment are unnecessary before 12 weeks’ gestation. This evidence may be used to inform international guidelines for Rh immunoglobulin administration following first-trimester induced abortion.

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“…Once appropriate intravenous access has been obtained and in patients with evidence of hemodynamic instability or concerns for ongoing bleeding, we initiate resuscitative efforts using blood products via activating our massive transfusion protocol. At our institution we currently use both LTO + WB whole blood (for all patents irrespective of age and sex), and standard blood component therapies 74,75 . Prior to patient arrival if there is any concern that the patient may warrant blood products based on the prehospital information provided, either a cooler of whole blood or an “ED Quick Pack” cooler is called for.…”

Section: Why We Do Itmentioning

confidence: 99%

“…At our institution we currently use both LTO + WB whole blood (for all patents irrespective of age and sex), and standard blood component therapies. 74,75 Prior to patient arrival if there is any concern that the patient may warrant blood products based on the prehospital information provided, either a cooler of whole blood or an "ED Quick Pack" cooler is called for. Our ED Quick Pack coolers are individual coolers stored with the trauma bay that contain two units of PRBCs and 2 units of fresh frozen plasma.…”

Section: How We Do Itmentioning

confidence: 99%

Damage control resuscitation in adult trauma patients: What you need to know

Lammers,

Holcomb

2023

J Trauma Acute Care Surg

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Death after injury is a worldwide epidemic. Hemorrhage as a cause of death represents the leading potentially preventable condition. Based on hard-won experience from the recent wars, and two decades of military and civilian research, damage-control resuscitation (DCR) is now widely used. This article will briefly describe the history of blood transfusion, outline “why we do DCR,” and then discuss “how we do DCR.” Modern DCR occurs both prehospital and in the hospital and has several main tenants. Currently, DCR focuses on the liberal use of temporary hemorrhage-control adjuncts, early use of whole blood or balanced blood product-based transfusions, mitigation of crystalloid use, hypotensive resuscitation to promote hemostasis and decrease coagulopathy, and correction of ongoing metabolic derangements, followed by rapid definitive hemorrhage control. These concepts have evolved from a series of lessons learned over time from both civilian and military trauma casualties, and DCR is now the standard of care in trauma resuscitation.

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Not as “D”eadly as once thought – the risk of D-alloimmunization and hemolytic disease of the fetus and newborn following RhD-positive transfusion in trauma

Cited by 19 publications

References 29 publications

Massive transfusion in trauma

Massive transfusion in trauma

Induced Abortion and the Risk of Rh Sensitization

Damage control resuscitation in adult trauma patients: What you need to know

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