Use of Group O RhD negative red cells

The Blood Service prepared Guidelines for the Use of Group O RhD negative red cells. These were endorsed by the National Blood Transfusion Committee on 17 May 2019

 

  • To provide recommendations for the use of Group O RhD 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 RhD negative red cells.

Every blood service has encountered recurrent shortfalls of Group O RhD negative red cells. This is predictable to some extent given that Group O RhD negative red cells are justifiably given to some non-Group O RhD 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 RhD negative red cells than is present in the general population.

Whilst only 9% of the Australian population are Group O RhD negative, the Blood Service issues of 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 dispoportionately 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.

Further enhancements of Group O RhD negative collections would be both difficult and costly.

  1. Wherever possible, red cells of the same ABO and RhD group as the patient should be chosen for transfusion, if stocks allow.

  2. Adequate stock 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 unneccessary use of Group O RhD negative blood for patients with other groups.

Mandatory
  • Group O RhD negative patients with anti-D

  • Group O RhD negative females with child-bearing potential

  • In emergency to premenopausal (<50 years) females of unknown blood group

  • Group O RhD negative children (males and females < 16 years)

Recommended
  • Group O RhD negative patients who will receive repeated transfusions, or are likely to become transfusion-dependent

    • For example: patients with haemoglobinopathies, aplastic anaemia, myelodysplasia

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

  • In order to conserve stocks of Group O RhD negative blood, Group O RhD positive blood should be used in larger volume blood replacement (eg, 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, it is acceptable to use Group O RhD positive red cells for Group O RhD 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 RhD negative patient, anti-D could fall after many years to an undetectable level, this is highly unusual with current sensitive screening techniques.