Traumatic hemorrhage and childbearing potential: Modern perspectives on Rh(D) alloimmunization

Hemorrhage is a leading preventable cause of trauma-related death. Early hemorrhage control and resuscitation with blood products are both critical for survival. The use of whole blood and low-titer type O blood has been shown to reduce overall transfusion volume, mitigating the effects of dilutional coagulopathy. Historically, Rh(D)-negative blood products have been prioritized for people of childbearing potential given the feared risk of alloimmunization and hemolytic disease of the fetus and newborn. However, the survival benefit of whole blood resuscitation seems to outweigh the estimated risks associated with sensitization, although no prospectively collected data provide a definitive solution to this ongoing health equity and ethical dilemma.