Use of O RhD-negative red blood cells: A nationwide, prospective audit

Background and objectives: Despite declining transfusion rates, overuse of O RhD-negative red blood cells (RBCs) risks the secure supply of this limited resource. A nationwide prospective audit was performed in Finland to understand the clinical use and inventory management of O RhD-negative units. Our aim was to identify areas where policy changes could help alleviate the shortage of O RhD-negative RBCs.

Materials and methods: The use of every O RhD-negative unit in Finland during a period of 1 month was reviewed. For each issued unit (n = 1105), unit age, urgency of transfusion, hospital and patient demographics, and specific reasons for issuing O RhD-negative units were recorded.

Results: Almost half of the O RhD-negative units (n = 529, 47.9%) were issued to non-O RhD-negative patients. Only 22.3% (n = 118) were issued for females under the age of 50. Of the units for ABO-nonidentical transfusion, one-third (32.5%, n = 172) were issued for emergency transfusion, two-thirds (67.5%, n = 357) for non-urgent transfusions. The most common reason for issuing an O RhD-negative unit was inventory management (n = 172, 48.2% of units issued for non-urgent transfusion). Most of these units were issued close to the unit expiry date.

Conclusion: This nationwide audit revealed that a significant proportion of O RhD-negative RBCs are used inappropriately. Clinicians should be educated on the appropriate use of O RhD-negative RBCs, and blood banks should develop strategies for inventory management to avoid issuing O RhD-negative units purely to prevent outdating.