1. Sample Identification: Since clerical
errors are the cause of the majority of hemolytic transfusion
reactions, all blood bank samples MUST be clearly and indelibly
labeled with:
a. Patient’s full name
b. Patient’s unit number
c. Phlebotomist’s identification
d. Date of phlebotomy
Inadequately identified samples will be destroyed and a properly
identified sample will be requested. The label on the top
copy of the Blood Product Requisition (#10693) should be used
as the tube label.
2. Sample Type and Volume: 10 mL of
anticoagulated blood in an EDTA (lavender top) tube is the
preferred specimen although 10 mL of clotted blood (red top
tube) is acceptable.
3. Sample Dating: Blood bank samples
may be used for three days (the draw date is day 0). Blood
bank samples from same day admit patients who have not been
transfused or pregnant in the preceeding three months may
be used for 30 days.
4. Neonatal Sample Requirement: 10
mL of maternal blood in a 10mL EDTA tube (lavender top) AND
10mL clotted cord blood (red top tube). If both a maternal
specimen or cord specimen are not obtainable, 2mL of blood
in a 10mL EDTA tube (lavender top) is required. No additional
sample is required for red blood cell transfusions for the
next four months unless an unexpected antibody is detected
in the preliminary work.
5. Type and Screen: ABO grouping, Rh
typing, and an antibody screen are performed on all specimens
sent to the laboratory. If an atypical red blood cell antibody
is detected, antibody identification testing will also be
performed.
6. Crossmatch: A crossmatch with an
in-dated sample is required for all whole blood, packed red
blood cells and deglycerolized red blood cells including autologous
units.
7. Preoperative Blood Requests: Requests
must be sent to the Blood Transfusion Service by 7:00pm the
day before the scheduled surgery.
8. Non-Preoperative Blood Requests:
All requests will be handled as routine unless “ASAP”
or “STAT” is indicated on the requisition. The
following guidelines should be used in setting the priority
of requests:
a. Routine - Transfusion is required to alleviate
moderate symptoms of anemia. A turnaround time of 3-5 hours
is acceptable.
b. ASAP - Transfusion is required to alleviate
marked clinical symptoms directly related to anemia or ongoing
hemorrhage. A turnaround time of 1.5-2 hours is acceptable.
c. STAT - Transfusion is required to correct
a potentially life threatening blood loss. The turnaround
time of 45 minutes is the absolute minimum that is allowed
for safe and complete pretransfusion testing.
d. EMERGENCY WAIVER: The need for transfusion
is so acute that blood products need to be released prior
to the completion of compatibility testing. The responsible
physician must sign the “Emergency Waiver” form
accepting the risks associated with the protocol. Compatibility
testing will be completed following release of the units.
Any unexpected incompatible results will be phoned to the
floor immediately.
9. Release of Crossmatched Units: Crossmatch
units of blood are generally held for a maximum of 24 hours.
Crossmatch units for operating room requests are generally
held until 7:00 am, the morning following surgery.
10. Suspected Transfusion Reaction Workup:
All suspected reactions (except urticarial only) must be reported.
The laboratory workup is intended to rule out clerical error,
hemolysis, or red cell sensitization as the cause of the symptoms.
The patient’s physician should order ancillary tests
such as urinalysis, blood cultures, plasma hemoglobin or haptoglobin
if clinically indicated. A report will be sent to the floor
following completion of the laboratory investigation. The
following should be sent when requesting a transfusion reaction
workup:
a. 10 mL anticoagulated blood in a properly labeled EDTA tube
(lavender top)
b. The remainder of the unit suspected of causing the reaction
along with any attached I.V. tubing or solutions.
c. A completed “Suspected Transfusion Reaction Report”
(Form #11603)
d. A completed Blood Product Requisition (#10693)
11. Tranfusion guidelines:
Transfusion care must be individualized to
each patient.
a. Packed Red Blood Cells
1) Hct < 21 for patients without cardiovascular compromise.
2) Among physiologically stressed patients, for the prevention
of ischemia:
Age < 40; Hct < 24
Age 40-60; Hct < 27
Age 60-70; Hct < 30
b. Platelets
1) Prophylactically for platelet count <10,000mm3 (adults),
<20,000/mm3 (children), <50,000/mm3 (neonate<72 hours).
2) <30,000 platelets/mm3 and bleeding or minor bedside
procedure.
3) <50,000 platelets/mm3 and intraoperative or postoperative
bleeding .
4) <100,000 platelets/mm3 and bleeding post bypass.
If the next-day platelet count is inadequate, check the 1
hour post-transfusion platelet count.
Do NOT transfuse platelets in setting of TTP or HIT.
Platelet transfusion may not be useful in ITP, PTP, DIC,
or uremia.
c. Fresh Frozen Plasma
1) Bleeding in patients with INR ≥ 2.
2) Bedside procedure and INR ≥ 2.
3) Prophylaxis (non bleeding) with INR ≥ 6.
FFP is generally not indicated for patients with INR <
1.5.
d. Cryoprecipitate
1) Bleeding in the setting of:
a) Fibrinogen < 100 mg/dL
b) Documented dysfibrinogenemia
c) von Willebrand’s disease
e. Modified Cellular Blood Components: Irradiated,
Leukoreduced, CMV-seronegative:
For each of the following categories of patients, appropriate
modifications (if any) of cellular blood components (RBCs
and Platelets) are listed.
