Abstract：
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.
摘要：
近年来，围绕损害控制复苏的好处的讨论有所增加，院前输血（PHT）的血液制品，以及使用全血超过成分治疗。血液产品的同时短缺以及在航空医疗运输期间提供PHT的愿望促使人们重新考虑将含RhD阴性红细胞的血液产品一线施用给有生育潜力的女性（FCP）的传统方法。鉴于只有7%的美国人O型血阴性，38%的人O型血阳性，一些计划可能仅限于向FCP提供RhD阳性血液制品。采用将RhD阳性血液制品一线给予FCP的做法，将PHT的益处扩展到此类患者，但这种做法确实会引发胎儿和新生儿未来溶血病（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很低，随着越来越多的航空医疗运输计划采用这种做法,受这种疾病影响的FCP数量将会增加.无论胎儿死亡率如何,监测和管理HDFN的过程也可能是时间密集和昂贵的。计划将含RhD阳性红细胞的产品进行PHT至FCP的航空医疗运输计划应该对病理生理学有基本的了解，预防,以及在引入这种做法之前对新生儿溶血病的管理。程序还应确保有一个可靠的过程来通知接收中心可能与RhD不相容的PHT，因为同种免疫预防是时间敏感的。接收患有PHT的患者的设施必须准备好识别，律师，并为这些患者提供同种免疫预防。这篇综述旨在为航空医疗运输专业人员提供对HDFN病理生理学和管理的了解，并为接受含RhD阳性红细胞PHT的FCP的早期管理提供模板。本综述还涵盖了接受创伤中心必须向接受RhD阳性红细胞PHT的FCP提供的初步检查和长期预期指导。
