The Blood Service prepared Guidelines for the Use of Group O Rh(D)-negative red cells. These were endorsed by the National Blood Transfusion Committee on 15 February 2008.
To provide recommendations for the use of Group O Rh(D)-negative red cells in order to conserve stocks and ensure availability for those patients for whom there is no alternative.
To provide a framework that is designed to ensure that hospitals and pathology providers work in a consistent, integrated manner to manage shortages of Group O Rh(D)-negative red cells.
Every blood service has encountered recurrent shortfalls of Group O Rh(D)-negative red cells. This is predictable to some extent given that Group O Rh(D)-negative red cells are justifiably given to some non-Group O Rh(D)-negative recipients, for example in emergencies before the patient's blood group is known.
The Blood Service strives to collect a higher percentage of Group O Rh(D)-negative red cells than is present in the donor population.
Between 7% to 8% of Australian blood donors are Group O Rh(D)-negative, whilst the Blood Service issues of Group O Rh(D)-negative red cells represent between 10% to 12% of total red cell issues.
This means that the donation frequency rate has to be high from these donors to keep up with demand.
Further enhancements of Group O Rh(D)-negative collections would be both difficult and costly.
Adequate stock management policies should be in place to minimise wastage of Group O Rh(D)-negative red cells arising from time expiry, and to avoid the need to electively transfuse to non-Group O recipients to prevent time expiry.
Adequate stocks of other groups should be maintained by hospitals to avoid the unnecessary use of Group O Rh(D)-negative blood for patients with other groups.
Sensitisation to the D antigen through blood transfusion must, where possible, always be avoided in women with child-bearing potential (<50 years when unknown). These guidelines aim to ensure continuous supply for this patient group.
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Indications for the Use of Group O Rh(D)-negative Red Cells |
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Mandatory |
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Recommended |
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Acceptable |
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In order to conserve stocks of Group O Rh(D)-negative blood, Group O Rh(D)-positive blood should be used in larger volume blood replacement (eg, more than 6–10 units of blood) in females with no child-bearing potential and adult males who do not have an existing or historical anti-D.
When Group O Rh(D)-negative blood is unavailable or in extremely short supply, it is acceptable to use Group O Rh(D)-positive red cells for Group O Rh(D)-negative female patients with no child-bearing potential and unimmunised males, provided no anti-D is detected on pretransfusion testing.
It should be noted that although there is a theoretical possibility that in a sensitised Rh(D)-negative patient, anti-D could fall after many years to an undetectable level, this is highly unusual with current sensitive screening techniques.
