A national database review of whole blood use among females of childbearing potential experiencing traumatic hemorrhage.

INTRODUCTION

The use of low-titer O whole blood (LTOWB) for traumatic hemorrhage is growing. Most LTOWB for use in adults is RhD-positive, which presents potential risks to females of childbearing potential (FCP); however, data on practice patterns are lacking. We sought to assess the use of LTOWB among FCPs compared to similarly aged males in facilities with documented LTOWB capabilities.

METHODS

We compared FCP (females 15-50 years of age) to similarly aged males (or sex unclassified/undocumented) who were included in the Trauma Quality Improvement Program database from 2020 to 2022. This database records transfusion volumes administered within the first 4 h after admission and patient demographics. We compared LTOWB use among FCPs versus similarly aged males using descriptive, inferential, and multivariable statistics.

RESULTS

There were 79,298 that met inclusion for this analysis. There were 16,823 (21%) FCPs, of whom, 2759/16,823 (16%) received any volume of LTOWB compared to 16,310/62,475 (26%) of the males. Furthermore, among LTOWB recipients, the median (interquartile range) volume administered to FCPs was 1162 mL (500-1000) compared to 1352 mL (500-1000, p = .003) for males. In our multivariable logistic regression analysis, males had a higher odds for the receipt of LTOWB compared to FCPs (odds ratio 1.76, 95% confidence interval 1.68-1.84) after adjusting for age, mechanism of injury, and composite injury severity score. These findings persisted on sensitivity testing.

CONCLUSIONS

Males were more likely than FCPs to receive LTOWB during trauma resuscitation in unadjusted and adjusted analyses. The reasons for such differences require elucidation in future prospective studies.