Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Transfusion. 2024 May;64 Suppl 2:S111-S118. doi: 10.1111/trf.17789. Epub 2024 Mar 19.
Low-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.
A web-based survey of blood bank directors was conducted to determine their hospital's RhD-type selection policies for blood issued for massive bleeding.
There 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%.
Hospitals 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.
由于数据表明低滴度 O 型全血（LTOWB）的使用可改善结果并提高安全性，因此其使用正在增加。使用的一个障碍是缺乏 RhD 阴性 LTOWB。本调查研究了美国医院在大出血紧急情况下选择血液制品 RhD 型的政策。
对血库主任进行了一项基于网络的调查，以确定他们的医院在大量出血时为血液发布选择 RhD 型的政策。
回复率为 61%（157 份中的 101 份），其中 95 份回复完整。受访者表示，40%（38/95）仅使用红细胞（RBC），60%（57/95）使用 LTOWB。对于发布 LTOWB 的医院（N=57），67%仅提供 RhD 阳性，2%仅提供 RhD 阴性，32%同时提供 RhD 阳性和 RhD 阴性 LTOWB。在使用 LTOWB 的地点，RhD 阴性 LTOWB 在育龄期女性（FCP）（46%）和儿科 FCP（55%）中比男性（4%）和男孩（24%）更常用或更倾向于专用。RhD 阳性 LTOWB 在男性（94%）和男孩（54%）中比成年 FCP（40%）或儿科 FCP（21%）更常用或更倾向于专用。在使用 LTOWB 的地点，对于成年 FCP，不允许使用 12%，对于儿科 FCP，不允许使用 21.4%，对于男孩，不允许使用 17.1%。
医院倾向于为女性发布 RhD 阴性 LTOWB，尽管由于供应限制，她们通常没有资格接受 RhD 阴性 LTOWB。与胎儿/新生儿溶血病（HDFN）罕见发生相比，LTOWB 的风险和益处需要进一步研究，在这种情况下，为有可能改善结果的女性保留一种治疗方法是有风险的。
