CONGRESS 2023 - Gender: lets talk about sex... and the implications for pathology
Blood Transfusion follows binary guidelines designed to protect against the formation of allo red cell antibodies capable of causing Haemolytic Disease of the Foetus and Newborn. For the first time, in 2021, the England and Wales Census included a gender identity question, ‘Is the gender you identify with the same as your sex registered at birth?’. 0.5% of respondents answered ‘No’ (262 000 people) of which 48 000 identified as a trans man, 30 000 as non-binary and 18 000 as another gender identity. Thus, there is a small, but significant, population of Transgender and Gender Diverse (TGD) individuals in society. What are the implications for Blood Transfusion? There are several scenarios: The lab could receive a sample labelled male and issue blood components which fail to meet the requirements of Kell negative and, if applicable, CDE negative red cells to someone with childbearing potential. The lab could receive an antenatal sample labelled male and the LIMS does not allow staff to perform all the same testing and product issuing as it would for a female. Some TGD individuals who have transitioned may get a new NHS number. Lab staff may be unaware and lab records are not merged which means all future transfusion requests are relying solely on antibody screening results with no historical transfusion information. The clinical consequences of these errors are missed incompatibilities, special requirements not met (SRNM) errors and immediate or delayed transfusion reactions with a potential for major morbidity or mortality.?All the circumstances described above illustrate that provision of healthcare is not uniform?for?all patients in the UK and could be described as indirect discrimination - a policy or practice that is identical for all people but has an unfair or disproportionate effect on a people with a protected characteristic.
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Blood Transfusion follows binary guidelines designed to protect against the formation of allo red cell antibodies capable of causing Haemolytic Disease of the Foetus and Newborn. For the first time, in 2021, the England and Wales Census included a gender identity question, ‘Is the gender you identify with the same as your sex registered at birth?’. 0.5% of respondents answered ‘No’ (262 000 people) of which 48 000 identified as a trans man, 30 000 as non-binary and 18 000 as another gender identity. Thus, there is a small, but significant, population of Transgender and Gender Diverse (TGD) individuals in society.
What are the implications for Blood Transfusion? There are several scenarios:
The lab could receive a sample labelled male and issue blood components which fail to meet the requirements of Kell negative and, if applicable, CDE negative red cells to someone with childbearing potential.
The lab could receive an antenatal sample labelled male and the LIMS does not allow staff to perform all the same testing and product issuing as it would for a female.
Some TGD individuals who have transitioned may get a new NHS number. Lab staff may be unaware and lab records are not merged which means all future transfusion requests are relying solely on antibody screening results with no historical transfusion information.
The clinical consequences of these errors are missed incompatibilities, special requirements not met (SRNM) errors and immediate or delayed transfusion reactions with a potential for major morbidity or mortality.?All the circumstances described above illustrate that provision of healthcare is not uniform?for?all patients in the UK and could be described as indirect discrimination - a policy or practice that is identical for all people but has an unfair or disproportionate effect on a people with a protected characteristic.