Routine Transfusion of Rh(D)-Positive Rbcs to Rh(D)-Negative Patients Designated as Do Not Resuscitate Conserves Rh(D)-Negative Red Blood Cell Inventory

Authors

• Julie Katz Karp, Thomas Jefferson UniversityFollow
• Jovanna Everetts, Thomas Jefferson University HospitalFollow
• Juliana Guarente, Thomas Jefferson UniversityFollow
• Angelica Vivero, Thomas Jefferson UniversityFollow
• Tiffany Bohr, Thomas Jefferson UniversityFollow
• Mary Harach, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

6-1-2026

Comments

This article is the author's final published version in Transfusion, Volume 66, Issue 6, June 2026, Pages 1108 - 1112.

The published version is available at https://doi.org/10.1111/trf.70209.

Copyright © 2026 The Author(s).

Abstract

Background: A minority of blood donors are Rh(D)-negative, and Rh(D)-negative red blood cell (RBC) products are often overutilized. As such, Rh(D)-negative RBCs may be difficult to maintain in blood bank inventory.

Study design and methods: We changed our blood bank laboratory policy to approve non-alloimmunized Rh(D)-negative patients to receive Rh(D)-positive RBCs for routine transfusion under defined criteria. Those criteria included Rh(D)-negative males (all ages) and females (aged >50 years) who were designated as do not resuscitate (DNR), either with or without intubation, in the electronic medical record.

Results: From August 15, 2024 through August 15, 2025, a total of 204 Rh(D)-negative patients met the above criteria and were approved to receive routine Rh(D)-positive RBC transfusions. Within that group, 23 patients received Rh(D)-positive RBCs. The remaining patients either did not require transfusion or were issued Rh(D)-negative RBC units. Since implementing this practice, a total of 68 Rh(D)-negative units were conserved during this time frame. Notably, 28 of the 68 units (41%) were type O, Rh(D)-negative.

Discussion: Rh(D)-positive RBCs can be routinely given to non-alloimmunized Rh(D)-negative patients who are not at risk for developing hemolytic disease of the fetus and newborn (HDFN). By creating clear guidelines for the routine administration of Rh(D)-positive RBCs to patients who are not at risk for HDFN, the inventory of Rh(D)-negative RBC units can be directed to those patients who would most benefit from this limited resource.

Recommended Citation

Karp, Julie Katz; Everetts, Jovanna; Guarente, Juliana; Vivero, Angelica; Bohr, Tiffany; and Harach, Mary, "Routine Transfusion of Rh(D)-Positive Rbcs to Rh(D)-Negative Patients Designated as Do Not Resuscitate Conserves Rh(D)-Negative Red Blood Cell Inventory" (2026). Department of Pathology, Anatomy, and Cell Biology Faculty Papers. Paper 491.
https://jdc.jefferson.edu/pacbfp/491

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

41968474

Language

English