Volume 36 Number 6 | December 2022
Carlo Ledesma, MS, MLS(ASCP)CMSHCMDLMCMQLSCM, MT(AMT), ASCLS Diversity Advocacy Council Councilor-at-Large
In emergency medical situations involving an exsanguinating patient and the ABO type is unavailable, uncrossmatched group O RBCs is the axiom of clinical management until the appropriate ABO/Rh type and pre-transfusion testing is completed. The current guidelines in the clinical management of an unknown blood type could be a life-threatening event for transgender patients and their future children.
Population studies show that alloantibodies capable of causing transfusion reactions are present within 2 percent of a given population and a prevalence rate of up to 0.6 percent for antibodies capable of causing immediate transfusion reactions4.
Previous studies demonstrated a 4 percent rate of anti-D development2, certainly a significantly low risk to accept, but a study by Yazer, et al demonstrated that anti-D is significantly higher2,3. The study analyzed transfusion records of Rh(D)-negative trauma patients transfused with Rh(D)-positive blood between the ages of 13-50 years3. The study showed a 34 percent rate of alloimmunization with no significant difference associated with the quantity of product transfused (p=.270, non-parametric trend test), and a 43 percent alloimmunization rate was observed in the cohort of Rh(D)-negative patients receiving Rh(D)-positive blood within 72 hours of index transfusion5.
“Updating the guidelines and recommendations to reflect our duty to patient-centered and affirmative care will ensure that safe practices in transfusion medicine remain in place and utilization of scarce blood products remain preserved and remain sensitive to the needs of all patients and the community.”
Implications of Guidelines for Transgender Patients
Given the knowledge of alloimmunization against anti-D is increasing and the growing transgender non-binary population (TGNB), it is imperative that the guidelines in the selection of Rh(D) type be updated because the current language in recommendations and practice guidelines does not consider the TGNB population. Trans females would not benefit from receiving Rh(D)-negative blood but transgender men may retain their capacity to become pregnant, and many had sensitizing events. This, in addition to the ability to experience pregnancy, render the standard pertaining to the emergency transfusion of uncrossmatched blood not applicable to transgender individuals. In the context of patient safety, this needs to be revisited expeditiously and failure to rectify the language may be construed as intentional harm to transgender male patients or their subsequent children. This guideline in emergency transfusion could potentially be a life-threatening event.
Updating the guidelines and recommendations to reflect our duty to patient-centered and affirmative care will ensure that safe practices in transfusion medicine remain in place and utilization of scarce blood products remain preserved and remain sensitive to the needs of all patients and the community. Most importantly, stay true and dedicated to preserving the tenet that governs the practice of medicine—First, do no harm.
- Saverimuttu, J., Greenfield, T., Rotenko, I., Crozier, J., Jalaludin, B., & Harvey, M. Implications for urgent transfusion of uncrossmatched blood in the emergency department: the prevalence of clinically significant red cell antibodies within different patient groups. Emergency Medicine, (2003). 15(3), 239-243.
- Yazer, Mark, et al. “Rate of RhD-alloimmunization after the transfusion of RhD-positive red blood cell containing products among injured patients of childbearing age: single center experience and narrative literature review.” Hematology 26.1(2021): 321-327.
- Williamson, L. M., & Devine, D. V. (2013). Challenges in the management of the blood supply. The Lancet, 381(9880), 1866-1875.
- American Association of Blood Banks. Standards Program Committee. (2020). Standards for blood banks and transfusion services.
- American Board of Internal Medicine Reaffirming Community Values: Transgender Rights in Health Care Matter [Blog post]. (2020). Retrieved from https://blog.abim.org/reaffirmingcommunity-values-transgender-rights-in-health-care-matter/
Carlo Ledesma is a DCLS Resident at Oklahoma City VA Medical Center and a Doctor of Clinical Lab Science Student at University of Kansas Medical Center and is the MLT Program Director at Rose State College in Midwest City, Oklahoma.