What is the Incidence of Early Antibody Formation after Resuscitation of Hemorrhage? A Comparison of RH(D)+ Whole Blood and RH(D)- Red Blood Cells in 3,531 Trauma Patients
Connor D. Purvis, Devi Bavishi, Mohammed Rigi, Alexandra P. Foster, Elene A. Clemens, Jan-Michael Van Gent, Thomas W. Clements, Bryan A. CottonObjective:
To evaluate the risk of red blood cell alloimmunization following transfusion of low-titer group O whole blood (LTOWB) compared with component therapy in severely injured trauma patients.
Summary Background Data:
LTOWB is increasingly used for trauma resuscitation because of logistical advantages and potential hemostatic benefits. However, concerns remain regarding alloimmunization, particularly anti-D antibody formation in Rh(D)-negative patients exposed to Rh(D)-positive blood products.
Methods:
A retrospective cohort study was conducted at a single Level I trauma center using trauma registry data from 2017–2023. Adult trauma patients (≥15 years) who received emergency release uncrossed blood products prehospital or shortly after admission were included. Patients were categorized by exposure to Rh(D)-positive LTOWB (WB group) or Rh(D)-negative component therapy alone (COMP group). Antibody screening was performed on admission and repeated at 72-hour intervals during hospitalization. The primary outcome was incidence of alloimmunization.
Results:
A total of 3,531 patients met inclusion criteria, including 2,103 in the WB group and 1,428 in the COMP group. Post-transfusion alloantibody formation occurred in 3% of WB patients (n=63) and 2% of COMP patients (n=32). Among WB patients who developed alloantibodies, anti-D antibodies accounted for 11% of detected antibodies, with anti-E most common (22%). In the COMP cohort, anti-D antibodies accounted for 20% of detected antibodies. In both groups, alloantibody formation was more common in Rh(D)-negative patients.
Conclusions:
LTOWB transfusion in severely injured trauma patients was associated with a low incidence of alloantibody formation comparable to component therapy, supporting the immunohematological safety of LTOWB in trauma resuscitation.