- The risk of serious morbidity or mortality resulting from traumatic haemorrhage should be prioritised over potential risk of alloimmunisation.
- Emergency use group O RBC are to be used only in an emergency to save a patient’s life and when the patient’s blood group is not yet confirmed.
- A pretransfusion specimen must be obtained as soon as possible, and where feasible prior to transfusion of any emergency use group O RBC. This will enable the transfusion service to provide units compatible with the patient’s group and minimise group O RBC use.
O RhD negative red blood cells (RBC) have historically been used for all emergency transfusions despite most of the Australian population being RhD positive. Group O RBC will enable a patient to survive a life-threatening situation.
The current demand for group O RhD negative red blood cells is 16.2 per cent of all RBC issued, whereas only 8.7 per cent of new Australian donors are O RhD negative (current as of September 2022).
Throughout 2022, this has resulted in serious, prolonged, and ongoing shortages of O RhD negative RBC which have impacted health services.
Large numbers of O RhD negative RBC are held for emergency use. However, most is not used for emergency purposes. Often it is electively transfused to non-Group O RhD negative patients to ensure the RBC do not expire (Blood Matters 2018).
National Blood Authority - National statement
In response to the ongoing severe shortage of O RhD negative RBC in Australia, the National Blood Authority (NBA) has prepared a National Statement for the Emergency Use of Group O RBC, which includes the use of group O RhD positive RBC.
This statement can be accessed from the National Blood website.
Recommendations for emergency use of group O red blood cells
To align Victoria with the National Statement, Blood Matters have worked with Safer Care for endorsement, education, and promotion of the appropriate utilisation of emergency use Group O RBC.
The resources and support tools developed to assist health services implement the recommendations are available for download below.
The following recommendations are aimed at reducing the demand for group O RhD negative RBC. These should be read in conjunction with Recommendations for emergency group O red blood cell use in Victoria communique:
Where the patient’s blood group is unknown:
- Group O RhD positive RBCs should be issued for:
- females > 50 years
- males >18 years (or based on organisational definition of paediatrics).
- Group O RhD negative RBCs should to be issued for:
- females of childbearing potential (≤50 years, including children)
- males ≤18 years.
- where the person’s age or sex cannot be determined, clinical judgement should prevail.
Where laboratories issue ‘packs’ for massive transfusion/major haemorrhage:
Make sure you consider patient safety when managing O RhD positive and O RhD negative RBC.
Where both emergency use O RhD positive and O RhD negative RBC are kept in satellite fridges:
Make sure you consider the management of these products. Including clear labelling and indications for use.
Inventory requirements and appropriateness of use
Health services vary in:
- clinical services
- patient demographics.
Each health service should evaluate their own requirements for emergency use group O RBC and hold appropriate emergency inventory for their site.
Regular review and audit of emergency group O RBC use and inventory appropriateness is encouraged.
An audit tool and policy have been developed to assist health services assess whether emergency group O RBC should be used:
Two clinical pathways (flow charts) have been developed for use within health services:
- Health services with an onsite transfusion service. An example of a health service where this clinical pathway may be appropriate is a large hospital which has a transfusion laboratory onsite which is operational 24 hours a day, 7 days a week.
- Health services with an offsite transfusion service or where the laboratory is not staffed 24 hours a day, 7 days a week. An example of a health service where this clinical pathway may be appropriate is a regional hospital with an Urgent Care Centre.
Depending on local health service policy some may choose to use swing tags on only O RhD positive emergency use RBC. Others will use swing tags on both O RhD positive and O RhD negative emergency use RBC.
If only O RhD negative emergency use RBC are held (for example, at a satellite fridge with maternity services) the use of a swing tag may not be required.
Your Blood Management Committee (or equivalent) will be able to assist your local policy.
- Emergency use O RhD positive swing tags:
- Emergency use O RhD negative swing tags:
A guide on how to use emergency group O RBC swing tags:
Promotion and education
An infographic and fact sheet are available to download and print for display in locations where emergency use group O RBC may be used. The infographic may also be used as a screensaver within health services:
Emergency use of group O red blood cell infographic:
Emergency use of group O factsheet:
Two PowerPoint presentations have been developed to assist health services inform and educate staff about emergency use group O RBC recommendations.
Three email signature tags are also available for promotion of emergency use group O RBC recommendations within your health service.
A management guide for emergency use group O red blood cells has been developed as a “how to” guide to help guide practice in relation to issues that may occur with the use of emergency use group O RBC. It may be consulted after the event or used to support education to prevent issues from occurring.
Clinical pathway guidelines
- Clinical pathway for emergency issue of blood with an onsite transfusion service
- Clinical pathway for emergency issue of blood for health services with an offsite or core hours transfusion service
- Emergency use O RhD positive Swing Tags
- Emergency use O RhD negative Swing Tags
- How to use emergency group O RBC swing tags
Policy and audit
- Emergency use group O RBC policy and use audit
- Emergency use group O audit template
- Emergency use group O RBC in Victoria PowerPoint slides for clinical education
- Emergency use group O RBC in Victoria PowerPoint slides for laboratory education
Email tags and screensavers
- Emergency use group O RBC Email Tag_1
- Emergency use group O RBC Email Tag_2
- Emergency use group O RBC Email Tag_3
- Emergency use group O RBC Fact Sheet
- Emergency use group O RBC Infographic/Computer screensaver
Management guides and communique
- Management guide for emergency use group O red blood cells
- Recommendations for emergency group O red blood cell use in Victoria – communique
Reviewed 03 March 2023