The Department of Defense Combat Casualty Care Research Program is sponsoring a consensus meeting on Emergency Transfusion in Females with Childbearing Potential: Mitigating the Risks of Hemolytic Disease of the Fetus and Newborn. The two-day meeting will take place at the Hyatt Regency in Bethesda, Maryland on Nov. 19 and 20, 2024. The first day is open to the public, while the second is reserved for expert panel voting. To register for the event, visit here.

The study is being conducted by the University of Pittsburgh, in cooperation with the Transfusion, Hemostasis and Oxygen Research Network and the AlloHope Foundation. It aims to create a multidisciplinary consensus statement for national recommendations focused on optimal transfusion strategies for females of childbearing potential who are at risk of experiencing life-threatening hemorrhage, as well as on screening and treatment recommendations to reduce the risk of hemolytic disease of the fetus and newborn, commonly referred to as HDFN. Several professional medical organizations and other stakeholders are participating in the study. Following the development of a consensus statement, the study's organizers will develop educational materials for at-risk women and their medical providers.

HDFN is a blood disorder caused by an incompatibility between the blood type and/or an inherited protein on the surface of red blood cells, called RhD factor, in a baby and its mother. This incompatibility prevents a mother's immune system from recognizing her fetus, which triggers a breakdown of red blood cells within the baby's bloodstream, called hemolysis, and ultimately leads to the development of anemia and jaundice in the fetus. When left untreated, severe anemia and jaundice can give rise to critical illness, hearing problems and brain damage. Fortunately, with appropriate treatments, these risks can be substantially reduced.

Although almost all women will undergo a test to identify their blood type early in pregnancy, emergency events requiring a blood transfusion may occur prior to the decision to conceive. In cases of severe hemorrhage, the risk of death outweighs the risk of potential reactions from a transfusion; therefore, even if the blood type of a female with childbearing potential is unknown, protocol dictates that a transfusion be administered.

Blood containing the RhD protein is more readily available than blood without it; therefore, current emergency protocols often utilize RhD-positive transfusions, particularly in the prehospital space or with massive transfusions during treatment of traumatic injuries. Because a transfusion of RhD-positive blood in a female of childbearing potential without the RhD factor can induce alloimmunization (an immune response triggered by the presence of foreign antigens), future adjustments to national recommendations and standards of care are necessary to support affected females. This is of particular interest to the Department of Defense, given the ever-increasing number of female warfighters at risk of injury.

"Bleeding patients must receive life-saving emergency blood without limitation or hesitation, regardless of gender," says U.S. Navy Capt. Travis M. Polk, a trauma surgeon and director of the Medical Research and Development Command's Combat Casualty Care Research Program. "We have an obligation to the military and civilian women who receive emergency transfusions to ensure that a deliberate process exists to screen and provide care for any potential downstream complications related to those transfusions, such as alloimmunization and risk of HDFN."

CCCRP funds a broad range of knowledge and material product solutions related to combat trauma for the current and future battlefield. This effort aligns to DoD priorities and supports the recently announced White House Initiative on Women's Health Research.