Traumatically Injured Women Less Likely Than Men to Receive LTOWB

Traumatically injured women are less likely to receive low-titer group O whole blood (LTOWB) transfusions within the first four hours of injury compared with traumatically injured men, according to research from investigators from the UPMC Department of Surgery and Pittsburgh Trauma and Transfusion Medicine Research Center. The findings were published in Transfusion last week.  

Investigators reviewed data from 79,298 patients in the American College of Surgeons Trauma Quality Improvement Program database, which records transfusion volumes administered within four hours of hospital admission. The research team then compared LTOWB use among females of childbearing potential (FCPs, ages 15-50 years) and similarly aged males. They also examined associations between LTOWB use and mortality.

Data indicated that 26% of males received LTOWB compared with 16% of FCPs. After adjusting for injury severity and other clinical variables, females of all ages were significantly less likely to receive LTOWB than males (odds ratio 1.76). The disparity was most pronounced among younger women, who received LTOWB approximately 40% less often than age-matched males. Older women (aged more than 50 years) also received less LTOWB than men, although the difference was smaller (20%).

While LTOWB administration was associated with improved 24-hour and in-hospital survival, a causal mediation analysis found that differences in LTOWB use did not explain observed differences in mortality between sexes. Notably, older women experienced increased mortality risk, which the authors suggest may relate to physiological changes after menopause. 

According to investigators, the clinical hesitancy to transfuse RhD-positive LTOWB in FCPs may stem in part from the potential risk of hemolytic disease of the fetus and newborn. The authors cited recent evidence indicating that the survival benefit of RhD-positive LTOWB in trauma outweighs the small risk of HDFN (estimated at about 0.3%). Survey results also demonstrated that most females are willing to accept RhD-positive blood products in emergency situations.

The researchers noted that several additional factors, including institutional transfusion policies, clinician bias, differences in perceived bleeding risk and systemic inequities, may all contribute to disparities in LTOWB use. “Understanding and addressing these disparities is critical for improving outcomes and ensuring that trauma care is equitable and evidence-based,” they wrote.