| Contents | ||
| General Information Specimen requirements Physician Order form Sunquest ordering Components ABO Rh compatibility tables Picking up blood products from the Blood Bank Transfusing blood Transfusion reactions Circular of Information for the Use of Human Blood and Blood Components(7/02) | Special situations: Leukoreduction of components Irradiation of components CMV testing of components Emergency release Neonatal transfusion Exchange transfusion Sickle cell patients Autologous donations Directed donations Therapeutic apheresis | |
General Information
- The transfusion service operates 24 hours per day, 7 days a week.
- Services provided include blood component preparation, compatibility testing, and other red cell antigen/antibody testing.
- All blood products are obtained from the Community Blood Center, Dayton, Ohio.
- The Transfusion Service is accredited by the American Association of Blood Banks and the College of American Pathologists. It is regulated by the Food and Drug Administration.
Specimens must be labeled and verified with the patient's armband:
- Patients First & Last name
- Medical record number
- Date collected
- Phlebotomist tech code
| Test | Specimen |
| Type & Crossmatch | 3.0 mL EDTA (purple top) or 3 EDTA bullet tubes |
| Type & Screen | 3.0 mL EDTA (purple top) or 3 EDTA bullet tubes |
| Type & Screen (for NICU patients only) | 1 EDTA bullet tube |
| Type & Hold | 3.0 mL EDTA (purple top) or 3 EDTA bullet tubes |
| Type (ABO/Rh) | 3.0 mL EDTA (purple top) or 1 EDTA bullet tubes |
| Direct antiglobulin test | 3.0 mL EDTA (purple top) or 1 EDTA bullet tubes |
Physician order form
A Physician Order form must be submitted whenever a crossmatch or a blood product for transfusion is ordered. The following must be completed on the form:
- Patient's first and last name
- Medical record number
- Product and amount ordered
- Indications ("TF number")
- Physician's name and signature
Sunquest ordering
| Test | SunQuest Ordering (REI) | Notes |
| Type & Crossmatch | XM |
|
| Type & Screen | TYAS |
|
| Type & Hold | THLD |
|
| Type (ABO/Rh) | TYPE |
|
| Direct antiglobulin test (direct coombs) | DAT | |
| ABO Titer | ABOT | |
| Indirect Coombs (antibody screen) | IAT |
Components
| Product | Storage Temp | Est. Vol. | Est. Hct | Crossmatch Required ? | Notes |
| Red blood cells (RBC), CPD | 1-6° C | 240 ml | 65-70% | Yes |
|
| RBC, AS-5 | 1-6° C | 340 ml | 55-65% | Yes |
|
| Platelets, random | 20-24° C | 55 ml | N/A | No |
|
| Platelets, apheresis | 20-24° C | 200-350 ml | N/A | No |
|
| Platelets, volume reduced | 20-24° C | varies | N/A | No |
|
| FFP thawed | 1-6° C | 150-290 ml | N/A | No |
|
| Cryo thawed | 20-24° C | 5-10 ml | N/A | No |
|
ABO Rh compatibility tables
| Red Blood Cell Products | |||
| Patient | 1st Choice | 2nd Choice | 3rd Choice |
| O Pos | O Pos | O Neg | |
| O Neg | O Neg | ||
| A Pos | A Pos | A Neg or O Pos | O Neg |
| A Neg | A Neg | O Neg | |
| B Pos | B Pos | B Neg or O Pos | O Neg |
| B Neg | B Neg | O Neg | |
| AB Pos | AB Pos or AB Neg | A Pos or B Pos | A Neg, B Neg, or O Neg |
| AB Neg | AB Neg | A Neg or B Neg | O Neg |
| Platelet Products | ||||
| Patient | 1st Choice | 2nd Choice | 3rd Choice | Last Choice |
| O | O | A or B | AB | |
| A | A | AB | B (volume reduced) | O (volume reduced) |
| B | B | AB | A (volume reduced) | O (volume reduced) |
| AB | AB | A or B (volume reduced) | O (volume reduced) | |
| FFP or Cryo | |||
| Patient | 1st Choice | 2nd Choice | 3rd Choice |
| O | O | A or B | AB |
| A | A | AB | |
| B | B | AB | |
| AB | AB | ||
Picking up blood products from the blood bank
- Only CMC employees may pick up blood products
- Blood will only be issued for one patient at a time
- Except for trauma and surgery patients, only one unit of blood will be issued at a time.
See the Nursing "Blood Administration" procedures for additional information
Transfusion reactions
All transfusion reactions must be reported to the blood bank and documented (as described in the Nursing "Blood Administration" procedures).
Leukoreduction of components
The policy at CMC is to use all leukoreduced products. Cellular products (RBC, Platelets, Apheresed Platelets) not already received as leukoreduced from CBC must be leukoreduced here prior to issue.
Irradiation of components
Indications for irradiation of cellular components (RBC and platelets) :
- Immunocompromised hematopoietic progenitor cell (HPC) or organ trans-plant recipients (this includes allogeneic and autologous HPC transplants)
- Patients with hematologic disorders who will be undergoing transplantation imminently
- Intrauterine transfusions
- Neonates undergoing exchange transfusion or use of extracorporeal membrane oxygenation
- Patients with Hodgkin’s disease
- Patients with congenital cellular immunodeficiencies
- Chronic Lymphocytic Leukemia patients receiving fludarabine phosphate.
- At CMC it is also our practice to irradiate cellular products for all neonatal patients up to age 4 months.
Once irradiation is ordered, all subsequent products must be irradiated unless the first irradiaton order was erroneous. Exception: once an infant reaches age 4 months, subsequent products do not need to be irradiated unless ordered by the physician.
CMV testing of components
- CMV negative requests are met through leukoreduction of 100% of RBC and Platelet products at CMC.
- NICU patients are an exception. Our neonatologists require CMV-seronegative RBC and platelets.
- FFP and cryo never need to be ordered as CMV negative.
- Uncrossmatched O Negative red cells are available for emergency release.
- An appropriately labeled sample must be submitted, preferably before uncrossmatched blood is issued, so that compatibility testing can be performed for issued units and any additional units.
- The ordering physician must sign an "Emergency Release of Red Blood Cells" form, either before or after transfusion. This form will be provided by the Blood Bank at the time blood is issued.
- Blood for neonatal patients can be issued based on a Type & Screen, without a full crossmatch, provided that group O cells are transfused and the antibody screen is negative.
- No subsequent testing will be required for the remainder of the admission until the patient reaches age 4 months.
- Contact the Transfusion Service immediately when an exchange transfusion is being considered to allow ample time for patient testing and obtaining blood products.
- Red cells transfused to Sickle cell patients must be tested as Sickle cell negative.
- Chronically transfused Sickle cell patients may be phenotypically matched for C, E, and K red cell antigens.
- It is the responsibility of the ordering physician to request Sickle cell negative units, and phenotype matched, if appropriate. The request must be documented on the Physicians Order form.
- Arrangements for autologous donation are made through the Special Donations department at Community Blood Center (937) 461-3450.
- When a patient has autologous blood it must be used before any other products.
- Autologous blood cannot be used for other patients.
- Autologous blood must be ABO-rechecked upon receipt, and must be crossmatched in the same way as regular units.
- Autologous blood does not need to be irradiated.
- Arrangements for directed donation are made through the Special Donations department at Community Blood Center (937) 461-3450.
- Directed donor blood cannot be used for other patients.
- Directed donor blood must be crossmatched in the same way as regular units.
- Directed donor units must be irradiated prior to issue.
- Paperwork to request directed donations is available from the CMC Transfusion service.
- Arrangements for directed donation are made through the Apheresis department at Community Blood Center (937) 461-3450
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