Study Highlights Gender Disparities in Trauma Blood Transfusions

Recent research conducted by scientists at the University of Pittsburgh School of Medicine has uncovered a significant gender disparity in the administration of whole blood transfusions to trauma patients. The study reveals that women who suffer traumatic injuries are substantially less likely to receive whole blood transfusions within the crucial first four hours post-injury compared to their male counterparts. This finding is particularly concerning given that whole blood transfusions are linked to reduced mortality rates for both genders.

Published ahead of a dedicated issue of the journal Transfusion, the research emphasizes the urgent need for a deeper understanding of the factors contributing to this sex-based inequality in medical treatment. The lead researcher expressed disappointment at the findings, highlighting the necessity for equitable medical practices that ensure all patients receive potentially life-saving interventions.

Significant blood loss remains the leading cause of preventable deaths related to trauma, with approximately 30,000 fatalities annually in the U.S. due to inadequate management of bleeding injuries. The University of Pittsburgh and its affiliated medical center, UPMC, are actively engaged in various national and international studies aimed at improving care for trauma patients.

The research team analyzed data from an American College of Surgeons database, which included nearly 41,000 female and 116,000 male patients who experienced traumatic injuries from 2020 to 2022 and received at least one liter of low-titer O whole blood (LTOWB) within four hours of hospital admission. LTOWB is commonly donated by individuals with type O blood, often referred to as universal donors, due to its low levels of antibodies against other blood types.

The study findings indicate that among younger female trauma patients under the age of 50, there is a 40% lower likelihood of receiving LTOWB compared to similarly aged males. Furthermore, women aged 50 and older also received LTOWB 20% less frequently than their male peers, a trend that persisted even after adjusting for injury severity.

Notably, the research indicates that the use of whole blood correlates with improved outcomes for both men and women. Specifically, patients who received whole blood experienced a 20% to 25% decrease in mortality risk. This consistent pattern underscores the importance of addressing the underlying causes of these disparities.

The researchers speculate that the lower rates of whole blood transfusions among women, particularly younger women, may stem from concerns regarding potential future pregnancies. Most LTOWB available for trauma care is RhD-positive, and if a RhD-negative female receives positive blood, she may develop antibodies against the RhD antigen. This is typically not a concern for her health but could pose risks during a future pregnancy if the fetus is RhD-positive.

Although the risk of fetal complications is estimated to be very low--around 0.3%--due to advancements in prenatal care, the existing fears among clinicians regarding maternal-fetal compatibility continue to influence treatment decisions. Experts argue that the potential risks of withholding life-saving treatment from women must be re-evaluated, particularly when considering the immediate life-threatening nature of trauma.

In a related study, researchers examined the treatment of women of childbearing age (ages 15 to 50) who were recorded in the trauma database. The findings indicated that men were nearly twice as likely to receive LTOWB compared to women in this demographic. Although surveys have shown that many women in this age group would accept RhD-positive LTOWB despite the minimal risks, only about half of the clinical institutions surveyed have policies allowing for this practice.

Experts in the field stress the need for a shift in perspective regarding the administration of RhD-positive blood to women of childbearing potential. With advancements in medical treatments that effectively manage potential complications during pregnancy, the focus should shift towards saving lives in emergency situations.