Keeping a handle on O- red blood cells

Alister Jones, Blood Health Adviser

Velindre University NHS Trust: Welsh Blood Service

This Bevan Exemplar project optimises use to ensure that O- will always be available for patients in Wales.


O D negative (O-) red cells can be given to patients of any ABO and D blood group, making them versatile and highly valuable. However, their versatility can mean that demand often outstrips supply. This project set out to improve stock management and clinical use of O- red cells to ensure a sustainable supply for patients in Wales.

Image of packet of rhesus D negative blood


The main aim of the project is to ensure that O- will always be available for patients with a genuine clinical need for O- red cells. The Welsh Blood Service Blood Health Team works collaboratively with hospitals in Wales to moderate the demand for O-, and maximise its potential benefits for patients.

The project concentrates on the journey of O- red cells leaving the Welsh Blood Service blood centres, specifically around:

In alignment with prudent healthcare principles, the project seeks to minimise any inappropriate variation of stock management practice amongst hospitals.


The use of audit and surveys is key to understanding current practices, but this can be very labour-intensive from a Blood Health Team and, more importantly, a hospital perspective: work is ongoing to secure resource to support this in future.

Deciding on appropriate, agreed levels for the issuing and wastage of O- is another challenge, however this will be of use when discussing data with the hospitals.

Changing clinical practice and behaviour around the use of O- is difficult. While there are guidelines, there is a lack of published evidence which can support discussions with clinicians.


The capacity of the Welsh Blood Service Blood Health Team to overcome these challenges has been greatly expanded by the establishment of the O- work-stream, who will continue to work on this project.

Next steps

Future plans for the project include:

“The Bevan Exemplar process has helped to bring clarity and purpose to this project.”

Alister Jones, Welsh Blood Service

Did you know?

8.2% of the population in Wales is O-, but, over the period October 2016 to September 2018, 15% of the total issues of O- red cells were from the Welsh Blood Service to hospitals in Wales.

Part of cohort Bevan Exemplar Projects 2017-18