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

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.