Whole blood transfusion saves lives, but women still receive less of it

Whole blood transfusion saves lives, but women still receive less of it

Traumatically injured women are significantly less likely to receive whole blood transfusions within the first four hours of injury compared to men, although whole blood is associated with reduced mortality in both women and men, according to new research led by University of Pittsburgh scientists.

The results were published ahead of a special issue of the journalTransfusionand highlight the urgent need to better understand the underlying reasons for gender-based inequality in the provision of potentially life-saving whole blood to everyone who would benefit from it.

“We want medicine to be equitable,” said Skye Clayton Skye Clayton, clinical research coordinator at Pitt's Trauma and Transfusion Medicine Research Center (TTMRC), who also works as an emergency medicine physician. “It was really disappointing to see these disparities, that women are at increased risk of not receiving life-saving treatment.”

Significant blood loss is the leading cause of preventable trauma-related death, with an estimated 30,000 people dying in the United States each year due to premature or inadequate hemorrhage care. Pitt and UPMC are leading several national and international studies designed to improve this care.

Clayton and the research team collected information from an American College of Surgeons database on nearly 41,000 women and 116,000 men who were traumatically injured between 2020 and 2022 and received at least one liter of Low-Titer O Whole Blood (LTOWB) within the first four hours of hospital admission. This type of blood is donated by a person with type O blood - commonly called a "universal donor" - and has low antibodies to type A or B blood.

Among traumatically injured people, women under 50 years of age were 40% less likely than men of similar age and women 50% less likely than their male counterparts. This finding held after adjusting for injury severity.

Interestingly, the use of whole blood is associated with better outcomes in both men and women. When whole blood was used, there was a reduced mortality risk of 20% to 25%. The magnitude of these results is difficult to ignore and consistent with results in other studies. “

Philip Spinella, MD,Senior Author,Professor of Surgery and Critical Care Medicine at Pitt and Co-Director of TTRMC

Clayton and Spinella aren't sure why women were less likely to have given whole blood, but suspect that younger women and girls were least likely to have given it because they can become pregnant later. The majority of LtowB available for trauma resuscitation are positive for the RHD antigen. If someone who is negative for that antigen receives positive blood, they can make antibodies against it. It is very unlikely to affect them during the trauma or their lives. But if a woman makes these antibodies after a blood transfusion and her fetus is positive for the antigens, then the mother's antibodies can attack the fetus's blood, which can be life-threatening to the unborn baby.

The risk of fetal death is estimated at about 0.3%, with very little advances in pregnancy and fetal medicine that will further improve and further reduce this risk. With proper care, this condition is treatable during pregnancy, resulting in a healthy baby. Spinella believes that a lack of knowledge about the low risk and advances in care have led clinicians not to give whole blood to younger women out of fear that it will affect a future fetus.

“You can’t get pregnant and have a baby if you’re dead,” Spinella said.

Spinella's colleague Mark Yazer, MD, professor of pathology at Pitt, is co-senior author of a companion study published online several weeks ago that will also be in the special issue ofTransfusion.

Yazer worked with colleagues at the University of Colorado Anschutz Medical Campus, including co-senior author Steven Schauer, to look specifically at women of childcare potential between the ages of 15 and 50 recorded in the American College of Surgeons trauma database. They found that the men were almost twice as likely to receive LtowB compared to women of child potential.

The team found that while several surveys have shown that women of birth potential would generally accept receiving RHD-positive LTOWB, despite the low likelihood that it could lead to complications with future pregnancies, only about half of clinical facilities surveyed have policies allowing the use of RHD-positive LTOWB in this population.

“This research builds on several years of work that Dr. Spinella and I have done with our colleagues at Pitt, Colorado, and others nationwide,” Yazer said. "Historically the transfusion community has feared giving RhD-positive blood to women of childbearing potential whose RhD-type was either negative or unknown during their trauma resuscitation because of the risk it potentially poses to future pregnancies. However, this risk is now highly manageable with heightened awareness of this problem and with modern treatments during pregnancy. We need to recalibrate the risk-benefit formula for giving RhD-positive LTOWB to traumatically injured women when RhD-negative is not available is and save more lives."

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