Blood Bank

 Crossmatch Lab-CH (10th Floor West), 903-0365
Open 24 hours daily
 Crossmatch Lab - UH, 2nd Fl, Medical Office Bldg.,
903-3951; Open 24 hours daily
 Perinatal & Consultation Lab-CH (10th Floor west),
903-0362, 0730-1700h, Monday through Friday.
 Bone Marrow Cryo Lab - UH, 2nd Floor, Medical Office Bldg, 903-3951; Flexible hours
 Apheresis - 1st floor, UH 903-3153 - Appointments only
 

PERSONNEL
Yuan S. Kao, M.D., Section Director, 903-2466; Charity Beeper # 679-7887
Cynthia A. Eicher, MHS, MT(ASCP)SBB, MLT Section Director; 903-2466, Charity Beeper #679-8426
Carlene F. Holbrook, MT(ASCP)SBB, CH-Crossmatch Lab Manager, 903-0365
Elina Juengling, MHS, MT(ASCP)SBB, UH Blood Bank Supervisor, 903-3951
Karen C. Kirkley, MT(ASCP)SBB, CH Perinatal Consultation , Lab Manager, 903-0362

 

SERVICES PROVIDED BY THE BLOOD BANK

• Issue blood components and derivatives.

• Investigation of blood groups and identify rare donor units for freezing.
• Investigation of blood cell related antibodies and provide antigen negative blood when appropriate.
• Consultation for therapeutic phlebotomy.
• Consultation for therapeutic and single donor apheresis.
• Peripheral blood stem cell harvests.
• Blood component preparation, including leukoreduction by filtration.
• Blood component irradiation.
• Cryopreservation of rare red blood cell units, bone marrow and peripheral blood stem cell harvests.
• Transfusion medicine consultations.
• Facilitate histocompatibility testing for transplant patients and disease association (send out test).
• Facilitate and provide directed and autologous blood donation.

 
Note: Most Blood Donor Services, including autologous, directed whole blood collections and therapeutic apheresis procedures are performed by staff from the Blood Center for Southeast Louisiana (BCSL). Directed and autologous blood donation services as well as replacement donations are locally available from BCSL staff, located at 2017 Tulane Avenue.

 Therapeutic whole blood phlebotomy services are arranged through the in-house I.V. team.
 

BLOOD SPECIMENS FOR CROSSMATCH & Rh IMMUNE GLOBULIN  Typenex link
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.
JCAHO (Joint Commission for Accreditation of Health-Care Organizations) CAP (College of American Pathologist) and AABB (American Association of Blood Banks) 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....
a. at MCL-Charity, stamp the Request for Crossmatch Form (MCL 1046) with patient's addressograph or obtain the computer- generated requisition.
b. at MCL-University, obtain the computer- generated requisition.
2. Ask the patient to state their name. Compare this with the requisition.
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).

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.
2. Remove the self sticking label and press onto an empty red 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 above.
4. Press the adhesive end of the band with all of the Typenex numbers onto the tube.
E. Attach the Typenex blood-recipient identification band to the patient and collect the sample.
1. Wrap the Typenex band with the empty red 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.
 

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 in 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
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 forms. (MCL 1046 - CH or A2K form - UH). For a special provision to handle the Emergency Medicine Department's (EMD) major trauma cases, see the EMD's policy and procedure manual.
 
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 unobtainable.
 

BLOOD PRODUCTS
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 transfusion.
 
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.
 
Each courier/messenger is allowed to transport/pick up blood components for one patient on each trip. Except in emergency cases, only one red cell unit will be issued on each trip.
 

BLOOD COMPONENTS AVAILABLE FROM BLOOD BANK
Red Blood Cells
Fresh Frozen Plasma. See Note 1
Cryoprecipitate
Platelets (see note 1)
Platelets, Pheresis (see note 2)
Granulocytes
* 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
Factor IX concentrate
Albumin, 5% & 25%
Plasma Protein Fraction
 
NOTE: 1
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.
 

NOTE: 2
Platelet utilization is monitored using platelet counts >20,000/ mm3.

NOTE: 3
Bedside filters are available for producing leukocyte-reduced RBC's and platelets. Leuko reduction filters are issued by the CH campus Blood Bank and by UH campus Central Medical Supplies.
 
SPECIAL PROCEDURES
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 either the MCL-Charity Blood Bank at 903-2466 or the MCL-University Blood Bank at 903-3951.
 

THERAPEUTIC HEMAPHERESIS
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), and leukapheresis. Indications for therapeutic plasma-pheresis can be found in JAMA 253:819-825, 1985.
Therapeutic apheresis can be performed in the Charity Hospital Apheresis Donor Area, 10th Floor west, the University Hospital Diagnostic Treatment Department (DTD), or the patient's bedside depending on the ambulatory capacity of the patient. In either event:
 
A. A written consultation (MCL 1205) with pertinent patient's data must be submitted in advance to the Blood Bank, 10th Floor West, Charity Campus or 2nd Floor, Medical Office Bldg, University Campus. Emergency consultation can be obtained by calling the Charity Campus Blood Bank at 903-2466 or the University Campus Blood Bank at 588-3951 as appropriate.
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 BCSL.)
D. The patient's primary physician should be available to manage the patient throughout the procedure. The procedure takes 3 to 8 hours.

TRANSFUSION REACTIONS
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 the Charity Campus call 903-0365; at the University Campus call 903-3951.
D. Draw a full 7 ml red top tube of blood, properly labeled, (using Typenex procedure if additional components are required), and submit to the Blood Bank along with the completed Transfusion Complication Form (MCLNO 811B) and the untransfused portion of the blood component plus recipient set and completed Confidential Medication Variance Form (NMR 0003). In addition, a lavender top tube (purple or EDTA) blood sample can be collected from the patient post-transfusion reaction for Direct Antiglobulin Testing.
To order the test in the SMS system use the code "TXRX".
E. Also submit the first voided urine specimen, properly labeled, to the Blood Bank when it becomes available.