- 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.
Recommendations for emergency use of group O red blood cells
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 21 April 2023