What is the risk of transfusing group O RhD-positive red blood cells to female service personnel of childbearing potential?

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.

Keywords: accident & emergency medicine; blood bank & transfusion medicine; fetal medicine; maternal medicine; military personnel; trauma management.