O D negative red cell toolkit

Information to help clinical and laboratory staff prevent wastage, and promote the safe and appropriate use, of O D negative red cells

Demand in 2022

Total red cell usage is falling due to improved surgical techniques and the implementation of Patient Blood Management (PBM) initiatives including the use of alternatives. However, demand for O D negative is increasing. Stability of the supply chain for universal components such as O D negative red cells remains a challenge for most blood services around the world and we're working hard to ensure adequate supplies are available when required.

Efforts are primarily focused on improvement of donor marketing to achieve a blood group mix appropriate to clinical demands. Approximately 7% of the UK population is O D negative, but average demand is greater than 13% and rising (this figure includes the impact of COVID).

We encourage you to make a difference and consider a range of initiatives to help conserve this precious resource.


NBTC appropriate specification for emergency red cells (JPAC website)

NBTC recommendations on the appropriate use of O D negative red cells 2019 (JPAC website)

Top tips to reduce the usage and wastage of O D Negative red cells from the East of England regional transfusion committee

Survey of group O D negative red cell use 2018 

Maintaining supply and reducing wastage 

When is it safe to transfuse O D negative K positive and negative red cells

Recommended alternatives to using O D neg (SHOT)


Good practice from Trusts

Experiences and initiatives on successfully managing stocks, wastage and appropriate use, for more information please contact the Trust.  

Guy's and St Thomas' NHS Foundation Trust (PDF 85KB)

Royal Derby Hospital (PDF 992KB)

University Hospital Southampton (PDF 361KB)

St Georges' University Hospital (PDF 109KB)

If you would like to share your Trust's good practice please contact your Patient Blood Management Practitioner or Customer Service Manager.


Designed for you to use alongside appropriate text in presentations and educational resources. Please acknowledge NHSBT as the author and please email our customer service team to let us know you've used them. 

O D negative red cells outside of the laboratory (PPT)

Laboratory management of O D negative red cells (PPT)

Consider using O D Pos for unknown males (PPT)

Give group specific blood asap in an emergency (PPT)

Review O D neg stock levels to reduce wastage (PPT)

Stock sharing (PPT) 

Total RBC demand vs O D neg demand graph (PPT)

When to use O D neg – female under 50 years in an emergency (PPT)

When to use O D neg – O D neg patient with anti-D antibodies (PPT)


Blood Stocks Management Scheme

See the further resources section on the Publications page, for using the issuable stock index (ISI), and learning points on O D negative.