ARCBS Guidelines for the use of Group O Rh (D) negative red cells
Prepared by the Australian Red Cross Blood Service and endorsed by the National Blood Transfusion Committee on 15 February 2008.
Purpose
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 cells.
Background
Every blood service has encountered recurrent shortfalls of Group O Rh (D) negative red cells. To some extent, this is predictable, 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 Australian Red Cross 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 - 8% of Australian blood donors are Group O Rh (D) negative, whilst ARCBS issues of Group O Rh (D) negative red cells represent between 10 - 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.
General principles 1. 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.
2. 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.
3. 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.
Indications for the use of Group O Rh (D) negative blood
Mandatory
- Group O Rh (D) negative patients with anti-D
- Group O Rh (D) negative females with child-bearing potential
- In emergency to premenopausal (<50 years) females of unknown blood group
- Group O Rh (D) negative children (males and females < 16 years)
Recommended
- Group O Rh (D) negative patients who will receive repeated transfusions, or are likely to become transfusion-dependent, for example patients with hemoglobinopathies, aplastic anaemia, myelodysplasia.
Acceptable
- In an emergency situation, Group O Rh (D) 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 Rh (D) 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 Rh (D) negative.
Use of Group O Rh (D) positive blood for Group O Rh (D) negative patients
- 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 (e.g. 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 pre-transfusion 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.