Quantifying when to switch from O Rh-negative to O Rh-positive red cells in bleeding O Rh-negative patients

On December 19, 1999, a CBBS e-network member asked the following question about policy for switching from group O Rh-negative to group O Rh-positive red cells in rapidly bleeding group O Rh-negative males and females:

"I assume that most blood bankers agree that hospital transfusion services need to incorporate a policy statement in their SOPs about when to consider switching from group O Rh-negative to group O Rh-positive red cells in rapidly bleeding group O Rh-negative males and females. I'm curious to know the wording of such a statement by various hospitals, specifically, do they specify numbers such as - when "x" units are transfused within "y" hours ... etc. I realize another variable is the tightness of the group O Rh-negative supply."

Only one e-Network member shared a reply, which follows:

1. Massive transfusion is defined as the infusion of a volume of blood approaching or exceeding the recipient's total blood volume within a 24 hour period. Rh-negative males may be switched to Rh-positive RBCs if they are > 14 years old and have received > 10 units of non-autologous blood in a 24-hour period, and the demand for RBCs is expected to continue. For Rh-negative males < 14 years old, in addition to the above criteria, our Medical Director's approval must be obtained. Rh-negative women < 55 years old may not be switched without our Medical Director's approval. We will obtain the number of available ABO Compatible, Rh-negative RBCs at our donor center, as well as in house, prior to contacting our MD. We also must have our MD's approval before switching patients with Anti-D to Rh-positive RBCs.

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