Survey of policies at US hospitals on the selection of RhD type of low‐titer O whole blood for use in trauma resuscitation

Abstract

AbstractBackgroundLow‐titer group O whole blood (LTOWB) use is increasing due to data suggesting improved outcomes and safety. One barrier to use is low availability of RhD‐negative LTOWB. This survey examined US hospital policies regarding the selection of RhD type of blood products in bleeding emergencies.Study Design and MethodsA web‐based survey of blood bank directors was conducted to determine their hospital's RhD‐type selection policies for blood issued for massive bleeding.ResultsThere was a 61% response rate (101/157) and of those responses, 95 were complete.Respondents indicated that 40% (38/95) use only red blood cells (RBCs) and 60% (57/95) use LTOWB. For hospitals that issue LTOWB (N = 57), 67% are supplied only with RhD‐positive, 2% only with RhD‐negative, and 32% with both RhD‐positive and RhD‐negative LTOWB. At sites using LTOWB, RhD‐negative LTOWB is used exclusively or preferentially more commonly in adult females of childbearing potential (FCP) (46%) and pediatric FCP (55%) than in men (4%) and boys (24%). RhD‐positive LTOWB is used exclusively or preferentially more commonly in men (94%) and boys (54%) than in adult FCP (40%) or pediatric FCP (21%). At sites using LTOWB, it is not permitted for adult FCPs at 12%, pediatric FCP at 21.4%, and boys at 17.1%.ConclusionHospitals prefer issuing RhD‐negative LTOWB for females although they are often ineligible to receive RhD‐negative LTOWB due to supply constraints. The risk and benefits of LTOWB compared to the rare occurrence of hemolytic disease of the fetus/newborn (HDFN) need further examination in the context of withholding a therapy for females that has the potential for improved outcomes.