BLOOD BANK SPECIMEN COLLECTION PROCEDURE
INTRODUCTION
Scientific and technical advances in blood group serology have made the transfusion of
blood a relatively safe procedure, but serious adverse effects of transfusion still result
because of human errors. The collection of a properly labeled blood sample from a
properly identified patient is critical for a safe blood transfusion. The individual who
collects the blood sample must identify the patient in a positive manner prior to collecting
the specimen. Only personnel who understand the importance of blood bank protocols
and adhere to them should be allowed to collect patient samples. Failure to provide
adequate concentration and attention to this task endangers the life of the patient.
The Altoona Regional Health System utilizes the Hollister Ident-A-Band recipient
identification system to ensure that patients who are potential blood or blood component
recipients are properly identified. The system consists of a numbered Hollister R-sheet
and a red patient identification wristband. These products are available upon request
from the blood bank.
The Hollister Ident-A-Band system is required at the time of specimen collection.
Specimens must be collected no more than 3 days before the anticipated blood need.
The entire Hollister identification process must be repeated every three days if
blood needs continue. The only exceptions to these guidelines are predeposited
autologous donations and pre-admission patients that provide the preadmission nurse
with a history of no transfusions or pregnancies with in the last three months. A Hollister
R-sheet MUST accompany the following requests:
1. Type and Crossmatch requests when red blood cells or blood components are
definitely needed for transfusion or surgery.
2. Type and Screen requests when blood products may be needed for transfusion or
surgery. Once a normal type and screen is completed, any requests for red blood cells
will be available in approximately 15 minutes after the blood bank is notified. If a
clinically significant unexpected antibody is detected in the Type and Screen
procedure, it is the Blood Bank’s policy to crossmatch and provide two units of
compatible red blood cells for the patient.
3. Draw and Hold requests are to be used when an “extra tube” will be collected and
held in the Blood Bank for future testing if specific orders become necessary. This
order is most often used internally for Labor Room patients and Trauma patients. It is
also used frequently (pending H&H results) for Medial Outpatients collected by
BMA Oncology, the Outpatient Clinics, or Home Nursing Agencies.
Blood Bank Specimen Collection
Page 1 of 7
4. The Hollister R-band should also be used for any Blood Bank request, even ABO and
Rh testing, when the patient will be coming to or remaining in the facility for the
purpose of treatment, diagnostic testing or surgery (e.g. D&E,). The Hollister IdentA-band system is not indicated for prenatal testing including antenatal Rh immune
globulin testing.
INITIATING A BLOOD BANK REQUEST
1. From an online facility, place the appropriate orders into the computer using the test
codes provided.
From an off-site facility, complete one of the Altoona Regional Health System
Laboratory Test Request Forms provided.
Special Instructions are included at the end of this section for requesting autologous
and directed donations.
2. If the Hollister Ident-A-Band system is to be used, the Hollister R-sheet is to be
completed in the following manner: (See Figure 1).
•
Specimen Tube Label - Top Right:
Patient’s full name including middle initial
Patient’s own Social Security Number (Not Spouse’s or Medicare Number)
Patient’s Date of Birth
Name of requesting physician
Date and Time of specimen collection
Phlebotomist’s initials
•
Blank Left Side of R-sheet:
Patient’s full name including middle initial (specimen label may be attached)
Date of Specimen collection
•
Chart Record – Lower Left:
Do Not Remove: This is for Blood Bank uses only. R Numbers are only to
be placed on specimen tubes. Do not remove R Numbers to be placed on the
patient’s chart. The R Number must not be documented on the chart in order
to avoid potential misidentification errors.
•
Patient Armband Insert – Bottom:
Patient’s full name including middle initial
Date and Time of specimen collection
Phlebotomist’s initials
NO OTHER IDENTIFIYING NUMBERS SHOULD BE INCLUDED ON
THE PATIENT’S HOLLISTER ARMBAND.
Blood Bank Specimen Collection
Page 2 of 7
BLOOD BANK SPECIMEN COLLECTION
Patient identification and specimen labeling are the two most crucial steps in
pretransfusion testing. A venipuncture must not be performed if there are any
identification discrepancies (Name, Social Security Number, Medical Record
Number, Date of Birth, etc.) between the physician’s order, laboratory test request
label, R-sheet or patient armband.
1.
The individual who will be collecting the specimen must unmistakably identify
the patient. The following procedure must be followed in order to do so:
A. Ask the patient to state his or her full name, including middle initial. Never
ask the patient to agree to a certain name. (e.g.: “Are you Mr. _____?”)
B. Confirm the Patient Identity using at least 2 unique identifiers.
Inpatients – Compare the hospital wristband information (name, medical
record number, social security number, date of birth) with the order
information on the label. If possible, ask the patient to state their social
security number (or date of birth in the absence of a SS#) to ensure that the
admission data is correct. The identifying numbers should be documented on
the R-sheet as well as on the patient tube. Never use room numbers or bed
labels as a source of patient identification.
Outpatients and Physician Office Patients – Ask the patient to state his or her
own social security number or to provide documentation. Do Not Use the
spouse’s social security number or a Medicare number. If the patient does not
have a social security number, you can substitute their date of birth. The
identifying numbers should be documented on the R-sheet as well as on the
patient tube.
C. Please Note: If an emergent situation exists where the identity of a patient is
unknown, a minimum of the Hollister R-Number and a Trauma Color alias
will suffice as two unique identifiers until other name and number information
becomes available. In Trauma or Massive Transfusion Protocol (MTP)
situations, group O Positive or O Negative blood may be transfused without
prior patient identification or specimen collection, but every attempt must be
made to get a sample to the Blood Bank as soon as possible for determination
of ABO/Rh, antibody screening, and compatibility testing.
2.
After patient identity has been verified, remove the patient armband insert from
the bottom of the R-sheet. It should be completed with the patient’s full name,
date and time of collection and phlebotomist’s initials. NO OTHER identifying
numbers (SS#, DOB, etc.) should be included on the Hollister armband. Insert
the labeled band into the red plastic armband provided. Secure the red armband
around the patient’s wrist. Please make sure all information is visible before
Blood Bank Specimen Collection
Page 3 of 7
attaching the armband. Allow sufficient room in the armband for comfortable
movement and possible swelling of the wrist, but snug enough to prevent removal
or accidental loss. NOTE: The patient should be instructed not to remove the
armband until discharge from the hospital. If the armband is removed prior
to transfusion or surgery, the entire process must be repeated.
3.
Perform the phlebotomy according to general specimen collection techniques.
Collect one 10-mL K-2 EDTA purple top tube. Other acceptable specimens
include a 10 mL plain red top tube along with the 5 mL EDTA tube. If difficult
phlebotomies or pediatric patients necessitate the use of smaller tubes, an absolute
minimum of one 5 mL or two 3 mL EDTA lavender top tubes should be collected.
Each tube submitted must be labeled with a Hollister R-number, name, and
second identifying number. Do not use microtainers for blood bank specimens
without consulting the blood bank before collection.
4.
All tubes must be completely labeled as follows before leaving the patient’s
bedside or exiting from the phlebotomy area:
A. The specimen tube label from the top right hand side of the R-sheet should be
placed on one of the 10 mL purple top tube in such a way that all of the
information on the label is clearly visible and a long narrow “window” is
created down the length of the tube. This “window” is necessary to enable
visible examination of the tube’s contents. This label must contain the
information specified in the above section “Initiating a Blood Bank Request”.
B. All tubes should be labeled with a minimum of the patient’s full name, a
second unique identifying number, date and time of collection and
phlebotomist’s initials. They must also have a Hollister R number sticker
attached to each specimen. Please use any of the three stickers in the vertical
row above the chart record sticker on the left side of the Hollister R-sheet.
C. If pediatric tubes are used, each tube must be labeled with all of the above
information including a Hollister R number sticker. If collection of
microtainers has been approved by the blood bank, they may be placed into an
empty 10 mL red top tube and the necessary labels placed on the larger tube.
D. Please Note: Improperly labeled tubes will not be accepted by the Blood
Bank for pretransfusion testing. Incompletely or inaccurately labeled
tubes will never be returned to the phlebotomist or collection area for
completion or correction once they have been submitted. In such cases
the R-sheet, patient identification process, and the phlebotomy must all
be repeated. The same applies if the patient armband has not been
applied or has been removed.
5.
All blood bank specimens should remain at room temperature in the original tubes
until they can be delivered to the blood bank. They should not be centrifuged to
Blood Bank Specimen Collection
Page 4 of 7
separate serum or plasma. Specimens should not be refrigerated. The patient
samples and all paperwork, including the R-sheet, should be transported to the
blood bank as soon as possible. The date and time of specimen arrival will be
documented by computer verification when the specimen is received in the lab.
CRITERIA FOR SPECIMEN REJECTION
•
Specimens received unlabeled or improperly labeled. No specimens will be
accepted unless the Hollister Ident-A-Band patient identification and specimen
labeling process is completed exactly as described in the previous sections. The
Blood Bank staff or members of the phlebotomy team may not, under any
circumstances, complete labeling after the blood samples are received in the
laboratory. All specimen labeling must be performed at the patient’s bedside at the
time of collection. Illegible forms or labels are unacceptable.
•
Specimens not received in the Laboratory within 8 hours of collection.
Specimens for pretransfusion testing should be processed as soon as possible to
ensure accurate ABO and Rh typing and optimal antibody detection.
•
Unacceptable tube received. K-2 EDTA is the preferred specimen for
pretransfusion testing. Serum or K-3 EDTA may be acceptable.
•
Specimens which are hemolyzed. Hemolyzed specimens may contain enough
soluble material or cellular stroma to interfere with typing reactions, detection of
clinically significant antibodies or compatibility testing by acting to neutralize
antibodies. Free serum hemoglobin may also mask antibody-induced hemolysis.
•
Quantity not sufficient for testing (QNS). Generally, a minimum of 6 mL of whole
blood yielding at least 3 mL of serum is required to provide adequate specimen
volume for antibody detection and compatibility testing. (See Specimen Collection
Section above for preferred specimen volumes.) Some testing may be performed on
smaller specimens, but could result in delays should large numbers of units become
necessary or a clinically significant antibody is detected.
•
Samples diluted with IV fluids. Whether collected from a phlebotomy site above an
IV line, or syringe – pulled from an infusion line, residual IV fluids can interfere with
serologic testing. The serum dilution will result in less sensitive antibody detection.
Some contaminant fluids may also result in spontaneous agglutination providing false
positive results.
•
Specimens lacking two (2) unique identifiers. The specimen must include the
Hollister R-number and at least one other unique identifier such as Trauma Color,
Name, Date of Birth, Social Security Number, Medical Record Number, etc.
Blood Bank Specimen Collection
Page 5 of 7
SUMMARY OF COMMON BLOOD PRODUCTS
Major
Indications
Function
Symptomatic anemia
Restoration of
oxygen carrying
capacity
Component
Red
Blood
Cells
Plasma
Platelets
And
Platelet
Apheresis
Cryoprecipitated
AHF
Factor
Concentrates
(Factors VIIa, VIII, IX,
and vWF available)
Deficit of labile and
stable plasma
coagulation factors,
TTP
Bleeding from platelet
dysfunction
abnormality or
thrombocytopenia
Hypofibrinogenemia,
von Willebrand’s
disease,
Factor XIII deficiency
Hemophilia A
Treat specific
coagulation
factor
deficiency
Blood Bank Specimen Collection
Not
Indicated
Pharmacologically
treatable anemia,
Coagulation
deficiencies
Source of labile and
stable plasma
coagulation factors
Conditions
responsive to
volume replacement
Provide adequate
hemostasis
Plasma coagulation
factor deficiencies,
ITP
Provides
Factor VIII,
Fibrinogen,
Factor XIII,
And vWF
Provides
specific
coagulation
factor
Conditions not
deficient in specific
factor
Conditions not
deficient in specific
factor
Page 6 of 7
AUTOLOGOUS AND DIRECTED DONOR INFORMATION
Autologous Donation – refers to the removal of blood or blood products from a donor or
patient for subsequent re-infusion. The use of preoperative pre-deposited autologous
blood can significantly reduce or completely eliminate allogeneic blood exposures. This
procedure is used most often in orthopedic, vascular urologic and cardiac surgery. For
procedures in which the likelihood of transfusion is remote, the use of preoperative predeposited autologous blood is not indicated.
Advantages of autologous donation include:
1.
Prevention of transfusion - transmitted disease
2.
Prevention of alloimmunization
3.
Reduction in adverse events during a transfusion (GVHD, etc,)
4.
Supplement area blood supplies
5.
Stimulate erythropoiesis
6.
Source of blood for patients with multiple alloantibodies
Disadvantages of Autologous Donations include:
1.
Outdating and discard of unused units of blood
2.
Increased cost and complexity of services
3.
Donor reactions
Directed Donation – allows potential blood component recipient to select the donors to
be used for anticipated transfusion events. The donor criteria are identical to homologous
donations, except for the fact that all of the potential directed donors selected must be
ABO and Rh compatible with the intended recipient.
All Autologous and Directed donations are arranged and collected by the Alleghenies
Region of the American Red Cross. Arrangement for Autologous and Directed donations
may be made by contacting the American Red Cross at 800-542-5663. All of the blood
components are collected and forwarded to Altoona Regional prior to the date of the
anticipated product need.
REFERENCES
Technical Manual, American Association of Blood Banks, Bethesda, MD, 15th Edition,
2005.
Blood Bank Specimen Collection
Page 7 of 7