(P-TS-108) Routine Transfusion of Rh(D)-Positive RBCs to Rh(D)-Negative Patients Designated as Do Not Resuscitate to Preserve Rh(D)-Negative Red Blood Cell Inventory

Background/Case Studies: A minority of blood donors are Rh(D)-negative. As such, Rh(D)-negative red blood cell (RBC) products are difficult to maintain in blood bank inventory. Rh(D)-negative RBCs should always be provided to Rh(D)-negative women of childbearing potential (defined at our institution as age ≤ 50 years) to prevent alloimmunization to the Rh(D) antigen. Prevention of anti-D is crucial to avoid anti-D mediated hemolytic disease of the fetus and newborn (HDFN). Other Rh(D)-negative patient populations, such as men or women of non-childbearing potential who are not alloimmunized to Rh(D), may safely receive Rh(D)-positive RBCs without concern for HDFN or incompatibility.

Study

Design/Methods: Starting on 8/15/24, our blood bank laboratory policy was changed to allow non-alloimmunized Rh(D)-negative patients to receive Rh(D)-positive RBCs for routine transfusion under defined criteria. Those criteria include Rh(D)-negative males of all ages and females aged >50 years, who are designated as do not resuscitate (DNR) in the electronic medical record. These patients are prospectively identified by periodic reviews of current inpatient lists by the blood bank Quality Coordinator. Once identified, patients will have a “note to tech” placed in the laboratory information system (LIS) which permits the routine issuance of Rh(D)-positive RBCs.

Results/Findings: From 8/15/24 through 4/30/25, a total of 147 Rh(D)-negative patients were identified as meeting the above criteria and allowed to receive routine Rh(D)-positive RBC transfusions. Within that group, 18 patients received Rh(D)-positive RBCs (Table 1). The remaining patients did not require transfusion, or they were issued Rh(D)-negative RBC units. A total of 41 Rh(D)-negative units were preserved during the above time frame due to this practice. Notably, 19 of the 41 units (46%) were type O, Rh(D)-negative.

Conclusions: Rh(D)-positive RBCs can be routinely given to non-alloimmunized Rh(D)-negative patients who are not at-risk for developing HDFN. By creating clear guidelines for the routine administration of Rh(D)-positive RBCs to patients who are not at risk for HDFN, transfusion medicine services can help to preserve the supply of Rh(D)-negative blood for those who are at high risk. Recently, more emphasis has been placed on developing conservative measures for Rh(D)-negative, and more specifically type O Rh(D)-negative, transfusions for patients who are able to safely receive Rh(D)-positive blood. As the potential for HDFN remains in women of childbearing potential, Rh(D)-negative RBC units should be preserved as much as possible for use in this vulnerable population.