Use of group O RhD negative red cells

Only 9% of the Australian population is Group O RhD negative, however the demand for Group O RhD negative red cells currently represent over 17% of total red cell issues. This means that the number of Group O RhD negative donors needs to be disproportionately higher than donors of other blood groups, and their donation frequency rate has to be high to keep up with the demand for their red cells.

Lifeblood prepared Guidelines for the Use of Group O RhD negative red cells to provide a framework for the stewardship of this valuable resource.

These were endorsed by the National Blood Transfusion Committee on 17 May 2019.

General principles

  1. Wherever possible, issue ABO and RhD group identical red cells for transfusion.
  2. Adequate inventory management policies should be in place to minimise wastage of Group O RhD negative red cells arising from time expiry, and to avoid the need to electively transfuse to non-Group O recipients to prevent time expiry.
  3. Adequate stocks of other groups should be maintained by hospitals to avoid the unnecessary use of Group O RhD negative blood for patients with other groups.

Indications for the use of Group O RhD negative red cells

Mandatory
  • Group O RhD negative patients with anti-D.
  • Group O RhD negative females with childbearing potential.
  • In emergency to premenopausal (<50 years) females of unknown blood group.
  • Group O RhD negative children (males and females < 16 years).
Acceptable
  • In an emergency situation, Group O RhD negative blood should be given while the patient's blood group is being established. 
    • Blood grouping should be carried out as quickly as possible to minimise the 'blind' use of Group O RhD negative blood, and this can be limited to no more than two units in most instances. 
    • Once the patient's blood group has been determined, a switch to group specific blood should be made. 
  • If blood for neonatal use is required and suitable group specific red cells are unavailable. 
  • If the specific phenotyped blood provided is Group O RhD negative. 

 

Use of Group O RhD positive for Group O RhD negative patients

  • In order to conserve stocks of Group O RhD negative blood, Group O RhD positive blood should be considered in larger volume blood replacement (e.g. more than 6–10 units of blood) in females with no childbearing potential and adult males who do not have an existing or historical anti-D.
  • When Group O RhD negative blood is unavailable or in extremely short supply, consider the use of Group O RhD positive red cells for Group O RhD negative female patients with no childbearing potential and unimmunised males, provided no anti-D is detected on pretransfusion testing.

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