A case for stocking O D+ red blood cells in emergency room trauma bays

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AABB Standard 5.27 requires transfusion services to have a process for urgent release of blood before completion of compatibility testing. Our institution endorses a policy for the emergency release of group O, D+ red blood cells (RBC; O+ RBC) to males and females at least 50 years of age. Our emergency department (ED) stocks 4 O− RBC units. To determine if O+ RBCs can replace ED O− RBCs, we performed a retrospective review.


Patients admitted to the ED between January 2001 and August 2011 and transfused emergency-release O− RBCs were identified. Data were collected on sex, age, length of stay, clinical status, ABO/Rh, RBC transfusions, and RBC antibody screen results.


A total of 498 ED O− RBC units were transfused to 268 patients (168 male, 100 female). A total of 322 units were transfused to males and 114 to females at least 50 years of age. Thirty-nine (14%) were D− with 18 receiving O+ RBCs. A total of 109 had follow-up antibody screens; one D− patient developed alloanti-D.


The findings support the placement of O+ RBCs in the ED. The majority of ED O− RBCs (88%) went to patients who qualified for O+ RBCs; a minority (1.5%) of patients were D− females less than 50 years of age. The rate of alloimmunization was low.

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