Elina Juengling, MHS, MT(ASCP)SBB,CQA(ASQ)
Transfusion Service – Carlene F. Holbrook, MT(ASCP)SBB
Service 3rd Shift – Michael
Immunohematology Reference Lab &
HIV Gilead Grant –
Sharon Stradley, MT(ASCP)SBB
Continuing Education – Karen Kirkley, MT(ASCP)SBB
SERVICES PROVIDED BY THE BLOOD
Issue blood components and derivatives.
Investigate blood groups and identify rare donor units for freezing.
Investigate red cell related antibodies and provide antigen negative blood
Consultation for therapeutic phlebotomy.
Consultation for therapeutic and single donor apheresis.
Blood component preparation, including whole blood for exchange transfusion /
Irradiated blood components
Cryopreservation of rare red blood cell units.
Transfusion medicine consultations.
Facilitate and provide directed and autologous blood components.
HIV Antigen / Antibody Combo
testing for exposure and source patients.
Note: Most Blood Donor Services, including autologous, directed whole blood
collections and therapeutic apheresis procedures are performed by staff from
The Blood Center. Directed and
autologous blood donation services as well as replacement donations are
locally available from The Blood Center.
Therapeutic whole blood phlebotomy services are arranged through the in-house
BLOOD SPECIMENS FOR TYPE & MATCH (TYPE & CROSS) , TYPE & HOLD,
& Rh IMMUNE GLOBULIN (Typenex
A. Only MD's, RN's and Hospital Phlebotomists may collect these specimens.
B. Labeling - It cannot be overemphasized that crossmatch and other blood
bank specimens MUST be correctly and adequately labeled.
TJC (Joint Commission for Accreditation of Health-Care Organizations) CAP
(College of American Pathologist) and AABB require that the patient and the
blood sample be positively identified at the time of collection.
C. Patient Identification
1. Requisition - before drawing blood sample obtain the computer- generated
2. Ask the patient to state their name and date of birth. Compare this with
3. Compare the name and hospital number on the requisition form with the
patient's wrist band. Any discrepancies should be corrected at this time
before drawing the patient's blood sample.
4. Sign "collected by" on requisition (slip or computer form).
5. A second person verifies
patient identification and signs requisition.
D. Preparing Typenex blood-recipient identification band.
1. Using the hospital arm band for information, a ball point pen, and a hard
surface, write the patient's first and last name,(include middle initial when
it appears on the hospital arm band), hospital number, date, time and the
name of the person who will collect the sample on the long label near the
clip. The verifier initials the Typenex armband.
2. Remove the self sticking label and press onto an empty pink top tube. The
information on the label is duplicated on the band within seconds.
3. Remove the protective backing from the end (this end has diagonal red
stripes) of the band opposite the clip to expose the adhesive surface. See #2
4. Press the adhesive end of the band with all of the Typenex numbers onto
E. Attach the Typenex blood-recipient identification band to the patient
and collect the sample.
1. Wrap the Typenex band with the empty pink top tube attached once around
the patient's wrist or ankle, number side out.
2. Firmly close clip to make the band tamperproof.
3. To separate the sample tube and its 14 numbered labels from patient, hold
clip firmly and tear the tube portion of the band to one side without raising
the band above level of clip. Three numbers remain on the Typenex band
attached to the patient.
4. Typenex band will remain on the patient for 4 days after which it may be
removed by using scissors to cut through the band.
BLOOD SPECIMENS FOR TYPE & SCREEN (NON-TYPENEX) See above Typenex
procedure section C (patient identification) steps 1-4. Record patient name, medical record
number, and date of collection on specimen.
ELECTIVE SURGICAL UNIT BLOOD PROTOCOL Scheduled Surgical Unit (ASU) -
Patients will have blood available on the day of surgery on a "Type and
Screen release" basis if:
1. Type and Screen, ordered from Elective Admit Clinic and completed prior to
admission, is less than one month old.
2. The antibody screen from the above sample is negative.
3. Patient was not transfused or pregnant (including abortion or miscarriage)
within the month. See note
4. A new Typenex labeled specimen is collected after admission and is sent to
the Blood Bank.
5. Patient name and hospital number appears on the Elective Surgery Schedule.
Note: ASU patients with a positive antibody screen and/or transfused or
pregnant within the previous 3 months MUST have a preop sample submitted the
day prior to surgery
UNCROSSMATCHED BLOOD POLICY
A. Uncrossmatched Blood will be released by the Blood Bank when MCLN form 0805
(Emergency Request for Uncrossmatched Blood) signed by physician is sent to
Blood Bank . A properly labeled Typenex blood sample must be submitted with
the appropriate lab form. For a special provision to handle the Emergency
Medicine Department's (EMD) major trauma cases, see the EMD's policy and
B. Blood Bank policy is to emergency issue up to four O Neg. RBC's.
Thereafter, O Pos RBC's will be issued if a patient typenex labeled sample is
Crossmatched units are routinely held in reserve for 3 days. At the request
of the clinician, and upon approval of the BB physician units can be held in
reserve for longer periods of time, provided the unit(s) is (are) within the
dating period, the patient has not received Red Blood Cells units in the
interim, and the blood inventory allows.
Autologous Red Blood Cells will be reserved only for the donor/patient. These
products must be crossmatched with a Typenex labeled sample prior to
Directed (designated) Red Blood Cells - drawn from family members and friends
- will be reserved for the patient up to one (1) week prior to the expiration
date. If not used by the patient, the blood will be placed in the general
inventory. Both Autologous and Directed Red Blood Cell Products must be
crossmatched with a Typenex labeled sample prior to transfusion.
Blood products are tubed via the
Translogic Tube System after the Blood Bank receives an electronic Issue Form
from SMS generated by the floor.
Each courier/messenger is allowed to transport/pick up blood components for
one patient on each trip in cases where the tube system is unavailable.
Except in emergency cases, only one red cell unit will be issued on each
BLOOD COMPONENTS AVAILABLE FROM BLOOD BANK
Red Blood Cells
Fresh Frozen Plasma. See Note 1
Platelets (see note 1)
Platelets, Pheresis (see note 2)
* Leuko-reduced, CMV neg, washed and/or Irradiated components are available
upon Path approval. See Note 3
BLOOD DERIVATIVES AVAILABLE FROM BLOOD BANK
Rh Immune Globulin
Factor VIII concentrate – now available from Pharmacy
Factor IX concentrate – now available from Pharmacy
Albumin, 5% & 25%
FFP utilization is monitored using PT 18 secs. or PTT 50 secs. The PT and PTT
should be repeated after 4 units of FFP are administered.
Platelet utilization is monitored using platelet counts >20,000/ mm3.
Bedside filters are available for producing leukocyte-reduced RBC's and
platelets. Leuko reduction filters are issued by the Blood Bank.
Requests for donor apheresis, therapeutic phlebotomy, therapeutic apheresis,
and other special procedures not covered in this handbook must be preceded by
a written consultation (MCLN 1205) to the Blood Bank Medical Director
providing all pertinent patient information. Emergency consultation for these
or other Blood Bank services can be obtained 24 hours daily by calling the
Blood Bank at 903-3099. Szczepiorkowski
ZM, et al, Guidelines on the Use of Therapeutic Apheresis in Clinical
Practice—Evidence-Based Approach from the Apheresis Applications
Committee of the American Society for Apheresis. Journal of
Clinical Apheresis 25:83–177 (2010).
Therapeutic hemapheresis (apheresis) is a procedure in which a blood
component is selectively withdrawn from a patient in order to achieve a
therapeutic goal. This includes erythrocytapheresis (exchange transfusion),
plasmapheresis (plasma exchange), thrombocytapheresis (platelet pheresis),
Therapeutic apheresis are ordinary performed at the patient's bedside
depending on the ambulatory capacity of the patient after :
A. A written consultation (MCL 1205) with pertinent patient's data is submitted
in advance to the Blood Bank, 1st Floor West, University Hospital.
Emergency consultation can be obtained by calling the Blood Bank at 903-3099.
B. Obtain an informed consent for each procedure.
C. Schedule at least 24 hours in advance if possible. (These procedures are
performed by staff from The Blood Center.)
D. The patient's primary physician should be available to manage the patient
throughout the procedure. The procedure takes 3 to 8 hours
In the event of a transfusion reaction:
A. IMMEDIATELY STOP the blood transfusion.
B. Change tubing and hang normal saline to keep line open.
C. Notify patient's physician; then the Blood Bank at 903-3099.
D. Draw a full 7 ml pink top tube of blood, properly labeled, (using Typenex
procedure), and submit to the Blood Bank along with the completed Transfusion
Complication Form (MCLNO 811B) , the untransfused portion of the blood
component plus recipient set. Do
Quantifi electronic report on-line. Order Transfusion Reaction workup in SMS.
E. Also submit the first voided urine specimen, properly labeled, to the
Blood Bank when it becomes available.
F. Results of the transfusion
reaction investigation will be available in CLIQ and also posted in the