Key messages
- 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.
The demand for group O RhD negative RBC has been as high as 17% of all RBC issued in Victoria, whereas only 6.5% of the Australian population are O RhD negative.
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 2024).
National Statements
National Statement for the Emergency Use of Group O RBC
In response to the ongoing shortage of O RhD negative RBC in Australia, the National Blood Authority (NBA) formed an expert working group consisting of representatives from key organisations to develop and publish the National Statement for the Emergency Use of Group O (National Statement), which includes the use of group O RhD positive RBC.
National Statement for the Emergency Use of Clinical Plasma
The expert working group has also developed the National Statement for the Emergency Use of Clinical (National Plasma Statement) to address the ongoing supply strain of group AB clinical plasma.
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 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 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 and the National Statement guidance when managing O RhD positive and O RhD negative RBC in 'massive transfusion packs.'
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
- size
- location
- 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 is encouraged.
An audit tool and policy have been developed to assist health services with the management of emergency Group O RBC.
Clinical pathways
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 operating 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.
Swing tags
Health services may choose to use swing tags on emergency use group O RBC.
Swing tags can be a helpful visual aid to identify emergency group O RhD positive and O RhD negative RBC.
- 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.
- Email signature tags are also available for promotion of emergency use group O RBC recommendations within your health service.
- An emergency use group O red blood cells 'how to' guide has been developed to provide guidance around the use of emergency use group O RBC.
Reviewed 29 September 2025