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The decision that a patient is in immediate risk of exsanguination and death is one that can only made at the bedside. That said, I think many trauma patients are overtransfused these days, particularly with plasma and platelets being given in most hospitals along with the first red cells. So I'd be very clear that the ordering practitioner believes that death is imminent without transfusion. And hopefully the patient would have already received tranexamic acid, and probably DDAVP as well to mitigate or even stop bleeding. These are evidence based, inexpensive, effective and safe drugs that can make the difference between surviving and not surviving, and between needing only a few units of red cells versus many more. Not all physicians have accepted these data, even trauma surgeons in some cases.

Enjoy the attached from 20+ years ago. ABOincompatible.pdf

But a perspective that is always needed, I'm sure.

If the total inventory is only 6 units at a rural hospital, I would stock 4 O Pos and 2 O Neg. I'm not suggesting every hospital should stock only 'O'!