An international investigation into O red blood cell unit administration in hospitals: the GRoup O Utilization Patterns (GROUP) study

Abstract

BACKGROUND Transfusion of group O blood to non‐O recipients, or transfusion of D– blood to D+ recipients, can result in shortages of group O or D– blood, respectively. This study investigated RBC utilization patterns at hospitals around the world and explored the context and policies that guide ABO blood group and D type selection practices. STUDY DESIGN AND METHODS This was a retrospective study on transfusion data from the 2013 calendar year. This study included a survey component that asked about hospital RBC selection and transfusion practices and a data collection component where participants submitted information on RBC unit disposition including blood group and D type of unit and recipient. Units administered to recipients of unknown ABO or D group were excluded. RESULTS Thirty‐eight hospitals in 11 countries responded to the survey, 30 of which provided specific RBC unit disposition data. Overall, 11.1% (21,235/191,397) of group O units were transfused to non‐O recipients; 22.6% (8777/38,911) of group O D– RBC units were transfused to O D+ recipients, and 43.2% (16,800/38,911) of group O D– RBC units were transfused to recipients that were not group O D–. Disposition of units and hospital transfusion policy varied within and across hospitals of different sizes, with transfusion of group O D– units to non‐group O D– patients ranging from 0% to 33%. CONCLUSION A significant proportion of group O and D– RBC units were transfused to compatible, nonidentical recipients, although the frequency of this practice varied across sites.

O– product transfusion, inventory management, and utilization during shortage: the OPTIMUS study

“…Interestingly, 43.6% of the O– RBCs in this study were transfused to non‐O– recipients. Perhaps some of these units were utilized in emergency bleeding situations where the recipient's ABO group was unknown, but the practice of transfusing O– RBCs to non‐O– recipients to avoid outdating and other reported uses of O– RBCs likely also contribute to this relatively high percentage …”

“…This practice results in the provision of ABO‐compatible units and prevents D– patients from becoming alloimmunized to the D antigen. O– RBCs may also be provided to non‐O or group O D+ (O+) recipients for a variety of reasons including times when there is a shortage of group‐specific RBCs, for neonatal patients, to support patients undergoing stem cell transplantation, for alloimmunized or sickle cell disease patients requiring phenotypic or genotype‐matched RBCs, and to reduce wastage due to expiration …”

Conservation of O– red blood cells: a fresh look at a shared responsibility

“…We commend the authors of the study for describing the utilization of ONEG RBCs in a large cohort of national and international centers, with special attention to age, sex, and location within hospital for transfusion recipients. These data and the work of others provide strong evidence that improvements are necessary in how ONEG RBCs are allocated. Reserving ONEG RBCs for those patients most vulnerable to the harmful consequences of developing D alloantibodies, such as women of childbearing age and those requiring chronic or recurrent transfusions throughout their lifetime, is critical.…”

“…Group O, D– red blood cells (ONEG RBCs) are a precious resource in health care, and as transfusion medicine physicians, we have the utmost respect for our blood donors and their provision of this valuable resource. Hospital‐based transfusion services are under immense pressure to maintain an adequate group O RBC inventory, not only to supply group O patients, but also for neonatal transfusions, stem cell transplant recipients, and in emergency settings, such as massive transfusion and trauma, when the ABO group and Rh type of recipients is unknown and pretransfusion testing is pending . As a result, blood centers are equally pressured to recruit group O, D– blood donors to keep up with the demand for this unique component, a task that is becoming more difficult amid concerns over sustainability of the US blood supply .…”

Potential impact of complement regulator deficiencies on hemolytic reactions due to minor ABO-mismatched transfusions

“…[31][32][33] An international survey of red cell transfusions reported that 54% of group O blood is transfused to non-group O recipients. 34 Furthermore, patients given multiple ABO nonidentical transfusions of platelets routinely develop IgG-positive direct antiglobulin tests and require increased red cell transfusion needs suggesting low-grade hemolysis. 7,33 As for the reported incidence of hemolysis in platelet transfusion, transfusing out-of-group platelets is common because transfusing ABO-matched platelets is not practical for every patient.…”