SUMMARY Objectives The current trends in RBC use and pre‐ and post‐transfusion Hb levels were analysed to improve practice and to provide international comparison. Background Indications for RBC transfusion have changed with growing scientific evidence. The lowest acceptable haemoglobin (Hb) level has decreased, and transfusing single units instead of pairs has become the new standard. Evidence‐based guidelines and patient blood management (PBM) programmes increase clinician awareness of rational RBC use. In Finland, however, no formal PBM programme has been established to date. Methods The study was registry‐based, retrospective and observational. All RBC transfusions for adult patients from 2011 to 2016 in the southern region of Finland were analysed. Results RBC usage decreased from 34·9 to 27·5 units per 1000 population (P < 0·001). The percentage of single‐unit transfusions increased from 57·9 to 66·7%, and the median pre‐ and post‐transfusion Hb levels decreased from 8·4 to 8·2 g dL−1 (P < 0·001) and 9·9 to 9·6 g dL−1 (P < 0·001), respectively. The proportion of transfusions with pre‐transfusion Hb ≥ 9·0 g dL−1 decreased during the study period but remained high, being 29·5% in 2011 and still 25·2% in 2016. Conclusions Consumption of RBCs has decreased despite aging population and increasing healthcare performance demands. The results indicate more rational and evidence‐based RBC use. Nevertheless, the transfusion rate and pre‐ and post‐transfusion Hb are still sufficiently high to enable more restrictive transfusion practice.

Background and Objectives Despite declining transfusion rates, overuse of O RhD‐negative red blood cells (RBCs) risks the secure supply of this limited resource. A nationwide prospective audit was performed in Finland to understand the clinical use and inventory management of O RhD‐negative units. Our aim was to identify areas where policy changes could help alleviate the shortage of O RhD‐negative RBCs. Materials and Methods The use of every O RhD‐negative unit in Finland during a period of 1 month was reviewed. For each issued unit (n = 1105), unit age, urgency of transfusion, hospital and patient demographics, and specific reasons for issuing O RhD‐negative units were recorded. Results Almost half of the O RhD‐negative units (n = 529, 47.9%) were issued to non‐O RhD‐negative patients. Only 22.3% (n = 118) were issued for females under the age of 50. Of the units for ABO‐nonidentical transfusion, one‐third (32.5%, n = 172) were issued for emergency transfusion, two‐thirds (67.5%, n = 357) for non‐urgent transfusions. The most common reason for issuing an O RhD‐negative unit was inventory management (n = 172, 48.2% of units issued for non‐urgent transfusion). Most of these units were issued close to the unit expiry date. Conclusion This nationwide audit revealed that a significant proportion of O RhD‐negative RBCs are used inappropriately. Clinicians should be educated on the appropriate use of O RhD‐negative RBCs, and blood banks should develop strategies for inventory management to avoid issuing O RhD‐negative units purely to prevent outdating.