A national database review of whole blood use among females of childbearing potential experiencing traumatic hemorrhage

Introduction: The use of low-titer O whole blood (LTOWB) for traumatic hemorrhage is growing. Most LTOWB for use in adults is RhD-positive, which presents potential risks to females of childbearing potential (FCP); however, data on practice patterns are lacking. We sought to assess the use of LTOWB among FCPs compared to similarly aged males in facilities with documented LTOWB capabilities. Methods: We compared FCP (females 15–50 years of age) to similarly aged males (or sex unclassified/undocumented) who were included in the Trauma Quality Improvement Program database from 2020 to 2022. This database records transfusion volumes administered within the first 4 h after admission and patient demographics. We compared LTOWB use among FCPs versus similarly aged males using descriptive, inferential, and multivariable statistics. Results: There were 79,298 that met inclusion for this analysis. There were 16,823 (21%) FCPs, of whom, 2759/16,823 (16%) received any volume of LTOWB compared to 16,310/62,475 (26%) of the males. Furthermore, among LTOWB recipients, the median (interquartile range) volume administered to FCPs was 1162 mL (500–1000) compared to 1352 mL (500–1000, p =.003) for males. In our multivariable logistic regression analysis, males had a higher odds for the receipt of LTOWB compared to FCPs (odds ratio 1.76, 95% confidence interval 1.68–1.84) after adjusting for age, mechanism of injury, and composite injury severity score. These findings persisted on sensitivity testing. Conclusions: Males were more likely than FCPs to receive LTOWB during trauma resuscitation in unadjusted and adjusted analyses. The reasons for such differences require elucidation in future prospective studies.