Not as “D”eadly as once thought – the risk of D-alloimmunization and hemolytic disease of the fetus and newborn following RhD-positive transfusion in trauma

Figures & data

Figure 1. Graphic representation of the risk of hemolytic disease of the fetus and newborn (HDFN) following the transfusion of RhD-positive RBCs to an injured RhD-negative female of childbearing age considering five critical events that must take place for HDFN to occur following trauma [20]. The percentages in brackets are the risks of each discreet event occurring; the dark shaded icons represent the cumulative risk of each event occurring as a percentage. For example, 76% of injured adults survive the trauma and 21% become D-alloimmunized, therefore the cumulative risk of fetal death from HDFN at this stage is approximately 16%, assuming the three additional events also occur. The overall cumulative risk of fetal demise from HDFN was calculated to be 0.3%.

Figure 2. Estimated risks of overall HDFN for RhD-negative females based on the highest (42.7%) and lowest (7.8%) reported D-alloimmuniztion risks. See text for further details of the assumptions made in this model. Reprinted from reference [25] with the kind permission of John Wiley and Sons, Inc.

Yazer MH, Delaney M, Doughty H, et al. It is time to reconsider the risks of transfusing RhD negative females of childbearing potential with RhD positive red blood cells in bleeding emergencies. Transfusion. 2019;59:3794–3799. doi:10.1111/trf.15569.

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Yazer MH, Spinella PC, Seheult JN. Risk of future haemolytic disease of the fetus and newborn following the transfusion of Rh(D)-positive blood products to Rh(D)-negative children. Vox Sang. 2022;117:291–292. doi:10.1111/vox.13169.

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