Section of Emergency Medicine, University of Chicago, Chicago, IL.
Department of Pathology, University of Chicago, Chicago, IL.
Air Med J. 2024 Jul-Aug;43(4):348-356. doi: 10.1016/j.amj.2024.03.012. Epub 2024 May 5.
Recent years have seen increased discussion surrounding the benefits of damage control resuscitation, prehospital transfusion (PHT) of blood products, and the use of whole blood over component therapy. Concurrent shortages of blood products with the desire to provide PHT during air medical transport have prompted reconsideration of the traditional approach of administering RhD-negative red cell-containing blood products first-line to females of childbearing potential (FCPs). Given that only 7% of the US population has blood type O negative and 38% has O positive, some programs may be limited to offering RhD-positive blood products to FCPs. Adopting the practice of giving RhD-positive blood products first-line to FCPs extends the benefits of PHT to such patients, but this practice does incur the risk of future hemolytic disease of the fetus and newborn (HDFN). Although the risk of future fetal mortality after an RhD-incompatible transfusion is estimated to be low in the setting of acute hemorrhage, the number of FCPs who are affected by this disease will increase as more air medical transport programs adopt this practice. The process of monitoring and managing HDFN can also be time intensive and costly regardless of the rates of fetal mortality. Air medical transport programs planning on performing PHT of RhD-positive red cell-containing products to FCPs should have a basic understanding of the pathophysiology, prevention, and management of hemolytic disease of the newborn before introducing this practice. Programs should additionally ensure there is a reliable process to notify receiving centers of potentially RhD-incompatible PHT because alloimmunization prophylaxis is time sensitive. Facilities receiving patients who have had PHT must be prepared to identify, counsel, and offer alloimmunization prophylaxis to these patients. This review aims to provide air medical transport professionals with an understanding of the pathophysiology and management of HDFN and provide a template for the early management of FCPs who have received an RhD-positive red cell-containing PHT. This review also covers the initial workup and long-term anticipatory guidance that receiving trauma centers must provide to FCPs who have received RhD-positive red cell-containing PHT.
近年来，人们越来越多地讨论损伤控制性复苏、院前输血（PHT）和使用全血替代成分治疗的益处。由于血液制品同时短缺，并且希望在航空医疗转运期间进行 PHT，这促使人们重新考虑传统方法，即首先向有生育能力的女性（FCPs）提供 RhD 阴性含红细胞的血液制品。鉴于美国只有 7%的人口血液类型为 O 阴性，38%的人口血液类型为 O 阳性，因此一些计划可能仅限于向 FCPs 提供 RhD 阳性血液制品。采用首先向 FCPs 提供 RhD 阳性血液制品的做法，将 PHT 的益处扩展到这些患者，但这种做法确实存在未来胎儿和新生儿溶血病（HDFN）的风险。尽管在急性出血的情况下，RhD 不相容输血后未来胎儿死亡的风险估计较低，但随着越来越多的航空医疗转运计划采用这种做法，受这种疾病影响的 FCPs 数量将会增加。无论胎儿死亡率的高低，监测和管理 HDFN 的过程也可能非常耗时和昂贵。计划对 FCPs 进行 PHT 的 RhD 阳性含红细胞制品的航空医疗转运计划应在引入该实践之前，对新生儿溶血病的病理生理学、预防和管理有基本的了解。此外，计划还应确保有一个可靠的流程来通知接收中心可能发生的 RhD 不相容 PHT，因为同种免疫预防是有时间限制的。接收接受 PHT 的患者的设施必须准备好识别、咨询并向这些患者提供同种免疫预防。这篇综述旨在为航空医疗转运专业人员提供对 HDFN 的病理生理学和管理的理解，并为接受 RhD 阳性含红细胞的 PHT 的 FCPs 提供早期管理模板。这篇综述还涵盖了接收创伤中心必须向接受 RhD 阳性含红细胞的 PHT 的 FCPs 提供的初始检查和长期预期指导。
