BSH24-PO69 Beyond binary: Necessity for updated transfusion guidelines for transgender and gender-diverse patients

Published Date: 25th April 2024

Publication Authors: Wright. P

Abstract
Transgender and gender-diverse (TGD) individuals, constituting 0.5% of the England and Wales population (262 000 individuals) according to the 2021 Census, have gender identities that differ from their assigned birth sex. TGD people can change their name, title and gender on their medical records at any time, including if they have not yet changed their legal gender via the Gender Recognition Act (GRA). Changing one's gender generates a new medical record with a new NHS number. The GRA safeguards gender recognition information, prohibiting its disclosure without the person's explicit consent.

In the Trans Lives Survey 2021, 70% of respondents reported being impacted by transphobia when accessing healthcare. Inclusive healthcare for TGD individuals requires acknowledgment of their identified gender in medical records. However, this results in complexity in many aspects of healthcare. Screening programmes rely on recorded gender, leading to exclusions (for example, trans males are not routinely invited for cervical screening). Some blood tests report results against normal ranges which differ between biological males and females (for example, haemoglobin and haematocrit). There is a unique risk for TGD patients requiring blood transfusion, where their childbearing potential and historical transfusion records may not be known. Blood transfusion is particularly affected, in part due to guidelines which are binary by sex. They are written to protect ‘females of childbearing potential’ from the risk of haemolytic disease of the fetus and newborn, but overlook trans males retaining childbearing potential.

Incidents and near misses within our transfusion laboratory exposed a lack of national guidance on providing transfusion services to TGD individuals safely, to the same standards as cisgender people, and while working within the GRA. We surveyed transfusion laboratories across North West England to establish regional practice. Most Trusts (8 of 10 responses) had no TGD policy or, if they did, had a policy which provided no guidance on clinical aspects of care. While several Trusts (3 of 10) reported incidents, none reported any formalised policy or procedure to prevent recurrence.

This anecdotal evidence highlights that we are not providing the same level of care to TGD patients; this can pose significant clinical risk, as well as being discriminatory. Given the large number of people this affects, and the significance of potential problems which can result, we hope that urgent conversations within the transfusion community can lead to robust and comprehensive guidance, to improve the care we provide to all patients.

Wright, P; Moss, K. (2024). BSH24-PO69 Beyond binary: Necessity for updated transfusion guidelines for transgender and gender-diverse patients. British Journal of Haematology. 204(Suppl 1), p.66. [Online]. Available at: https://dx.doi.org/10.1111/bjh.19398 [Accessed 8 January 2026]