Abstract：
BACKGROUND: Low-titer group O whole blood (LTOWB) for treatment of hemorrhagic shock sometimes necessitates transfusion of RhD-positive units due to short supply of RhD-negative LTOWB. Practitioners must choose between using RhD-positive LTOWB when RhD-negative is unavailable against the risk to a female of childbearing potential of becoming RhD-alloimmunized, risking hemolytic disease of the fetus and newborn (HDFN) in future children, or using component therapy with RhD-negative red cells. This survey asked females with a history of red blood cell (RBC) alloimmunization about their risk tolerance of RhD alloimmunization compared to the potential for improved survival following transfusion of RhD-positive blood for an injured RhD negative female child.
METHODS: A survey was administered to RBC alloimmunized mothers. Respondents were eligible if they were living in the United States with at least one red cell antibody known to cause HDFN and if they had at least one RBC alloimmunized pregnancy.
RESULTS: Responses from 107 RBC alloimmmunized females were analyzed. There were 32/107 (30%) with a history of severe HDFN; 12/107 (11%) had a history of fetal or neonatal loss due to HDFN. The median (interquartile range) absolute improvement in survival at which the respondents would accept RhD-positive transfusions for a female child was 4% (1%-14%). This was not different between females with and without a history of severe or fatal HDFN (p = .08 and 0.38, respectively).
CONCLUSIONS: Alloimmunized mothers would accept the risk of D-alloimmunization in a RhD-negative female child for improved survival in cases of life-threatening bleeding.
METHODS: A survey was administered to RBC alloimmunized mothers. Respondents were eligible if they were living in the United States with at least one red cell antibody known to cause HDFN and if they had at least one RBC alloimmunized pregnancy.
RESULTS: Responses from 107 RBC alloimmmunized females were analyzed. There were 32/107 (30%) with a history of severe HDFN; 12/107 (11%) had a history of fetal or neonatal loss due to HDFN. The median (interquartile range) absolute improvement in survival at which the respondents would accept RhD-positive transfusions for a female child was 4% (1%-14%). This was not different between females with and without a history of severe or fatal HDFN (p = .08 and 0.38, respectively).
CONCLUSIONS: Alloimmunized mothers would accept the risk of D-alloimmunization in a RhD-negative female child for improved survival in cases of life-threatening bleeding.
摘要：
背景：治疗失血性休克的低滴度O组全血（LTOWB）有时需要输血RhD阳性单位，因为RhD阴性LTOWB供应不足。当RhD阴性时，从业者必须选择使用RhD阳性LTOWB，以防止女性生育潜力成为RhD同种免疫的风险，未来儿童面临胎儿和新生儿溶血病（HDFN）的风险，或使用RhD阴性红细胞的成分疗法。这项调查询问了有红细胞（RBC）同种免疫史的女性，他们对RhD同种免疫的风险承受能力与RhD阳性输血后对受伤的RhD阴性女童的存活率提高的可能性相比。
方法：对RBC同种免疫母亲进行调查。如果受访者居住在美国，并且至少有一种已知会导致HDFN的红细胞抗体，并且至少有一次RBC同种免疫妊娠，他们就符合资格。
结果：分析了107例红细胞同种异体免疫雌性的反应。有32/107（30％）有严重HDFN病史；12/107（11％）有由于HDFN引起的胎儿或新生儿丢失史。受访者接受RhD阳性女性输血的生存率中位数（四分位数范围）绝对改善为4％（1％-14％）。有和没有严重或致命HDFN病史的女性之间没有差异（分别为p=.08和0.38）。
结论：在RhD阴性的女性儿童中，接受同种免疫的母亲会接受D-同种免疫的风险，以改善危及生命的出血病例的生存率。
方法：对RBC同种免疫母亲进行调查。如果受访者居住在美国，并且至少有一种已知会导致HDFN的红细胞抗体，并且至少有一次RBC同种免疫妊娠，他们就符合资格。
结果：分析了107例红细胞同种异体免疫雌性的反应。有32/107（30％）有严重HDFN病史；12/107（11％）有由于HDFN引起的胎儿或新生儿丢失史。受访者接受RhD阳性女性输血的生存率中位数（四分位数范围）绝对改善为4％（1％-14％）。有和没有严重或致命HDFN病史的女性之间没有差异（分别为p=.08和0.38）。
结论：在RhD阴性的女性儿童中，接受同种免疫的母亲会接受D-同种免疫的风险，以改善危及生命的出血病例的生存率。
