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

Weighing the risk of hemolytic disease of the newborn versus the benefits of using of RhD‐positive blood products in trauma

“…However, if more available RhD‐positive blood products are to be used, there is the risk of D‐alloimmunization in the recipient. Providing RhD‐positive transfusions to FCP is controversial and the decision to do so is nuanced and complex as other authors have summarized 12 . The rate of D‐alloimmunization is not currently known in children.…”

“…Providing RhD-positive transfusions to FCP is controversial and the decision to do so is nuanced and complex as other authors have summarized. 12 The rate of D-alloimmunization is not currently known in children. Estimates for the risk of D-alloimmunization in injured adolescents and adults ranges from 7.8% 13 to 42.7%, 14 with many studies finding rates between 10% and 30% for general hospitalized patients.…”

Considering equity in transfusion medicine practice

“…3 As such, the current practice of using A plasma when the blood type is unknown puts individuals of certain populations at potential increased risk of harm. 4,5 As we try to move from race-based to race-conscious medicine, it is important to recognize that data based on individuals of European ancestry does not necessarily apply to all patients. 6 Additional considerations apply to the use of whole blood.…”

“…These include the psychological toll on the patient, healthcare costs and risks related to intrauterine transfusion. 4 A recent meta-analysis evaluated the perinatal outcomes of 2439 pregnancies requiring 6010 intrauterine transfusions for red cell alloimmunization. There was an estimated perinatal mortality rate of almost 17% with exchange transfusions performed on 50% of neonates.…”

“…However, it is important to note that questions have been raised regarding the data supporting the efficacy and safety of transfusing incompatible plasma and whole blood. 4,5 We also would like to point the authors and journal editors towards the 2021 AMA Manual of Style "Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals." 14 Race-conscious medicine requires T A B L E 1 Distribution of ABO types by "race or ethnicity".…”