Clinicians are increasingly using RhD-positive low titer group O whole blood (LTOWB) for life-threatening bleeding, given its safety and lifesaving potential. However, for RhD-negative patients, this can lead to complications if they become pregnant, as antibodies formed during the transfusion can attack the fetus’s red blood cells, causing hemolytic disease of the fetus and newborn (HDFN), which can lead to anemia or death.
Philip Spinella from the University of Pittsburgh notes that while the risk of severe HDFN is less than 1% for RhD-negative patients who receive RhD-positive LTOWB, the benefits often outweigh the risks, as this approach can significantly improve survival rates in trauma cases. Surveys show most patients, including women, are willing to take this risk to increase their chances of survival.
Spinella and his team are conducting trials to find optimal treatments for such patients, although results will take years. In the meantime, the Allo Hope Foundation is working to educate about alloimmunization and HDFN and establish safe treatment guidelines. Bethany Weathersby, the foundation's founder, created it after losing her daughter to HDFN and aims to prevent other families from experiencing similar tragedies.
The foundation, along with the THOR Network Foundation, is also advocating for better care guidelines, despite some resistance from the medical community. In November 2024, they met with experts to develop evidence-based guidelines to improve outcomes for women with severe bleeding and reduce the risk of fetal death in alloimmunized women. These guidelines will help both care providers and patients seeking proper treatment for this condition.