Blood Bank Instructions
Request and Release of Blood/Blood Components
At the time of infusion, a “Blood Transfusion Record” must be
completed for each unit of blood or component ordered. The
“Blood Transfusion Record” prints in the Blood Bank and will
be available at the time of issue.
Split RBCs will only be separated immediately prior to
administration. Washed RBCs must be ordered in advance of
transfusion because they are washed at our Blood Center.
Blood will be released only to Intravenous Therapy
Technicians, RNs, LPNs, and CNAs.
Exception: Surgery (main Operating Room [OR]/
Cardiovascular Operating Room [CVOR]) has trained orderlies
for the release of blood and has a Blood Administration Policy
unique for Surgery.
Only 1 unit will be issued at each instance for 1 patient, unless
an emergency situation exists where 2 units will be infused
simultaneously to the same patient or during dialysis when the
second unit is infused right after the first unit. The first unit is
infused in approximately 15 to 20 minutes.
Note: Under no circumstances can blood be simultaneously
issued to 1 individual for 2 different patients.
In an extreme emergency, the physician may not want to wait
for completion of compatibility testing prior to release of the
blood. In this situation, blood can be released immediately, but
the physician must sign an “Emergency Transfusion Release”
form. Even though an emergency situation exists, a “Blood
Transfusion Record” must be completed. Since the testing is not
complete, we cannot generate a computer “Blood Transfusion
Record.” A preprinted “Blood Transfusion Record” (P-523)
must be stamped with patient information and brought to the
Blood Bank at issue. The crossmatch will be commenced
immediately and the respective nursing station notified to stop
the infusion of blood if any incompatibility is noted. Blood
Bank results will be transmitted to the nursing service after
crossmatch has been completed.
Turnaround times for uncrossmatched and crossmatched blood
are as follows:
• An Emergency Transfusion Release for uncrossmatched
blood requires an “Emergency Transfusion Release”
form. Group O Rh-negative packed cells could be issued
in approximately 5 to 10 minutes.
• ABO and Rh type-specific blood requires an
“Emergency Transfusion Release” form and a specimen
to be drawn, processed, and typed. This request takes
approximately 20 to 25 minutes.
• A full crossmatch for blood takes approximately 50 to 65
minutes. This includes the time for the specimen to be
drawn, processed, and crossmatched.
• A type and screen takes approximately 40 to 50 minutes.
This includes the time for the specimen to be drawn,
processed, and tested.
At any time, a type and screen can be converted to a crossmatch.
The immediate spin crossmatch would take an additional 5 to 10
minutes, a full crossmatch will take an additional 20 to 25
minutes.
These times are approximations and they vary due to
emergency interruptions, equipment malfunction, different
clotting times, difficulty encountered in drawing the patient,
and available blood supply. If blood is needed sooner than
anticipated, it will have to be taken as an Emergency
Transfusion Release.
Outpatient Transfusion
Outpatient transfusions are performed in accordance with the
standards that apply to inpatient transfusion. The transfusion is
performed in 3C under medical supervision and the patient must
be observed for an appropriate period of time after the
transfusion. The patient is also instructed as to the occurrence of
possible adverse reactions following the transfusion and is also
given an information sheet, “Blood/Blood Component
Transfusion,” by Nursing.
A doctor’s prescription is required for any outpatient
transfusion. Outpatient transfusions that qualify for Short Stay
Care are scheduled through Central Scheduling in advance by
the doctor’s office. Outpatient transfusions that are observation
admissions will be scheduled through Central Registration. The
Blood Bank must also be notified and given a copy of the
prescription with the intended transfusion date. The
prescription must indicate the diagnosis justifying the
transfusion and a hemogram, blood. It is recommended that
another individual accompany the outpatient.
Return/Storage of Unused Blood to Blood Bank
Blood will be held in the Blood Bank refrigerator until time for
administration.
Exception: The only exception will be surgical patients whose
blood may be held in the OR or CVOR refrigerator.
Blood cannot be held in any other refrigerator or at ambient
temperature for more than 30 minutes. If initiation of infusion
is unsuccessful, blood should be returned to the Blood Bank
immediately, the reason should be documented in the
laboratory information system. Once a unit has been returned to
the Blood Bank, it will have to be signed out again, and a new
“Blood Transfusion Record” completed if it is going to be
infused.
Transfusion Reactions
If a reaction occurs, the transfusion should be stopped, the
Blood Bank notified, the tubing clamped, and the attending
physician notified for further instructions. Follow instructions
on the “Transfusion Reaction” form. Order a “STAT”
Transfusion Reaction workup in the computer so that a post
reaction specimen will be drawn for Blood Bank to test. The
blood bag, saline, and tubing must be returned to the Blood
Bank, along with a completed “Transfusion Reaction Report”
form. The type of reaction must also be noted on the “Blood
Transfusion Record.” Two post-reaction urinalysis should be
collected, and a bilirubin should be ordered 5 to 7 hours later.
Care should be taken when discontinuing the blood to keep
blood bag in sterile condition. When a transfusion reaction
work-up has been completed by the Blood Bank and evaluated
by 1 of the pathologists, 1 copy of the “Transfusion Reaction
Report” form will be returned to the chart with the pathologist’s
interpretation. The pathologist’s evaluation will also be
documented on the patient’s report in the computer.
Cancellation of Blood
All blood routinely ordered will be held for 48 hours and then
automatically cancelled. Blood must be re-crossmatched after
48 hours with a fresh specimen.
Exception: Pre-admit surgical patients requiring an ABO/Rh
and antibody screening may have their blood drawn up to 14
days prior to surgery if they have not been pregnant or
transfused within the last 3 months.
Surgical Blood Order Schedule (SBOS)
The SBOS is a list of the different operative procedures that
require pre-operative testing from the blood bank. This list
has been approved by the respective medical staff committees
and administration. The SBOS serves as a guideline in
estimating the needs for particular surgical procedures and
should be consulted when pre-surgical testing is ordered.
Variations dependent on patient history and medical condition
are expected and therefore, this table is considered a
guideline. If the physician’s orders exceed the SBOS, the
orders will override the SBOS. Clinical judgment is required
for procedures not listed on the SBOS. If a surgical
procedure is not listed on the SBOS, pre-operative testing or
blood may not be required.
Cord Blood Testing
All newborns of mothers who have O-positive and Rh-negative
blood will have a cord blood work-up performed. Cord blood
work-up testing consists of an ABO and Rh typing, direct
Coombs, and bilirubin (total and direct).
All cord blood specimens will be brought to the Blood Bank and
labeled with the mother’s addressograph information. The
Nursery will order the required testing under the baby’s account
number with an additional message of: CORD BLOOD,
Mother’s MR # --------.
Neonatal Transfusion
It is imperative that full information be available to the Blood
Bank before blood is issued for neonatal transfusion. At the
time before the blood is ordered, the Blood Bank will need to
know if the requesting physician wants the blood to be <7 days
old, cytomegalovirus-negative, irradiated, and to lack
hemoglobin S. If prior work has not been done at Palos
Community Hospital, duplicate reports of prenatal blood
groupings, typing, antibody studies, and titers must be
submitted to the Blood Bank well before the expected date of
delivery so that suitable blood can be available. The mother’s
blood specimen is used for crossmatching.
Autologous Donation and Transfusion
Autologous donation is the removal of one’s own blood to meet
anticipated transfusion needs for planned, elective surgeries. A
patient’s own blood is the safest blood that he/she can receive.
The risk of exposure to blood-borne infectious diseases from
transfusion is eliminated by transfusion of one’s own blood.
Autologous blood may be the only suitable way to supply blood
for patients who have rare blood types and/or multiple blood
group antibodies. The patient may donate more than one unit
provided they pass a mini-physical and meet established
guidelines for autologous donations. The last donation should
not be drawn within 72 hours of the scheduled surgery.
Autologous blood can be stored in the refrigerator for 35 to 42
days and is reserved for the exclusive use of the patient. For a
medically demonstrated need and the physician’s written
request, the autologous red blood can be frozen and stored
longer. Anyone wishing to become an autologous donor must
have his/her physician complete a “Request for Autologous
Donation” form. These forms are available in the physicians’
offices and the Blood Bank. The patient can then contact one of
Heartland Blood Center’s drawing and distribution centers
(Tinley Park) to schedule an appointment for his/her donations.
Autologous donor units are subjected to the same tests as units
drawn from other blood donors. After the units are processed,
they are delivered to the hospital prior to the scheduled surgery
date. The physician of the autologous donor is notified of any
abnormal test results.
Directed (Designated) Donation
Directed donation is one in which patients select their own
donors to met anticipated blood needs for planned surgeries or
future scheduled transfusions. This type of donation is not
intended to be used on an emergency basis.
A “Request and Consent for Designated Donors” form must
first be completed by the patient’s physician. These forms are
available in the physician’s office and the Blood Bank. It is
important that the patient’s blood type and Rh are known and
recorded on the form. If the physician request directed donors
for a patient, potential donors who are unaware of their type and
Rh may have the tests performed at the hospital with an order
from a physician. In most cases, patient and directed donor
should be the same type and Rh unless noted otherwise on the
form by the requesting physician. After this form has been
completed, eligible donors should contact 1 of the Heartland
Blood Center’s drawing and distribution centers (Tinley Park)
to schedule on appointment for their donations. After
collection, these units are subjected to the same tests as other
donated blood. All directed products will be irradiated and
leukoreduced. To allow ample time for collection, testing,
processing, and delivery to the hospital, donors must donate at
least 3 to 5, but not more than 12, working days (excluding
Sundays
and holidays) before the date of surgery or intended use.
Directed donor units are tagged specifically for the designated
patient and held exclusively for that patient Once the hospital
receives the directed donor unit, it is tested with the patient’s
blood for compatibility. In most cases, there are no problems.
However, if the directed blood cannot be used for the patient or
fewer than the requested number of designated units are
available, the patient’s physician will be contacted. The donors
will be notified of any abnormal test results. Directed donors
are irradiated.
Intraoperative Autotransfusion (Cell Saver)
Surgery manages and coordinates procedures and the Blood
Bank supervisor/technologists supervise the quality assurance
for the Intraoperative Autotransfusion Program utilizing an
automated cell saver system. Blood that is shed during or after
a surgical procedure is salvaged, processed, and returned to the
patient in an attempt to diminish the patient’s exposure to
homologous blood products.
Coverage is provided by an outside service.
Leukocyte Reduced (Prestorage) Blood Products
All RBCs and pheresed platelets are prestorage leukoreduced.
Regardless if the physician orders them or not, our blood center
will provide prestorage leukoreduced RBCs and pheresed
platelets. Nursing is to include any other requirements
(cytomegalovirus negative, irradiated) with the order.
Leukocyte Removal Filters
Leukocyte removal filters are available in the Blood Bank for
RBCs and pheresed platelets that are not leukoreduced. When
nursing picks up the blood, the leukocyte removal filter will be
dispensed also. Leukocyte removal filters for RBCs and
pheresed platelets will be available in the event of unavailability
of prestorage leukoreduced RBCs and pheresed platelets.
Rh-Immune Globulin
Rh-Immune globulin is used to prevent the formation of active
antibodies in the Rho(D) negative, individual who has received
Rh(D)-positive RBCs. Exposure to Rh-positive RBCs can
occur as a consequence of pregnancy, abortion, delivery, or
transfusion of an Rh-negative recipient with Rh-positive RBCs.
Abortion, either spontaneous or induced, ectopic pregnancy,
abdominal trauma, and amniocentesis may cause fetal-maternal
hemorrhage.
Any female patient within this category must have an Rhimmune globulin profile performed to determine whether or not
she is an Rh-immune globulin candidate. If Rh-immune
globulin is administered antepartum, it is essential that the
mother receive another dose of Rh-immune globulin after
delivering a Rho(D)-positive or Du-positive (weak D) infant.
Rh-immune globulin should be administered intramuscularly
within 72 hours. The patient should be given an Rh-immune
globulin booklet to read and an identification card to carry. If
the patient has received Rh-immune globulin antepartum, it is
very important that the hospital Blood Bank be notified with
this information prior to delivery.
Additional Information:
• Antepartum mother should meet the following criteria in
order to be considered a candidate for Rhimmunoglobulin.
• Mother must be Rho(D) negative.
— The mother must not already be immunized to the
Rho(D) factor.
• Postpartum mother should meet the following criteria in
order to be considered a candidate for Rh-immune
globulin:
— Mother must be Rho(D) negative.
— Mother must not already be immunized to the
Rho(D) factor. If the mother was given Rh-immune
globulin antepartum (28 weeks), passive antibody
may be detected in the mother’s serum up to 3
months following the injection. It is important to
know if the mother has received Rh-immune
globulin antepartum so that laboratory tests can be
interpreted correctly. (Passive antibody is not
stronger than a 1:4 dilution.)
— Mother’s baby must be Rho(D) positive or Du
positive (weak D).
— Mother’s baby should have negative direct
Coombs’s test.
• A positive direct Coomb’s test of the cord blood does
not of itself preclude the administration of immune
globulin. The direct Coomb’s may be positive for 1 of
the following reasons:
— Mother is immunized to Rho(D) and prenatal tests
were in error, were not done, or were not reported.
— Mother is immunized to a factor other than Rho(D)
and the baby is positive for that factor.
— Mother and baby are ABO incompatible and the
baby’s cells have absorbed the antagonistic
maternal antibody of the ABO system. Rh-immune
globulin should be administered to an Rh-negative
woman if the baby is Rh positive even though the
direct Coomb’s test is positive, presumably due to
ABO incompatibility.
— Baby may have a positive direct Coomb’s due to
passive antibody if the mother was given
prophylaxis (28 weeks).
• Rh-immune globulin must be given within 72 hours after
delivery for complete protection. With each delivery
opportunity for exposure to fetal cells is repeated. The
protection given at the delivery of the first baby does not
protect the mother from exposure to antigen received at a
later time; hence, Rho(D)-immune globulin must be
given immediately following each pregnancy.
— It has been suggested that a miscarriage can serve
as a primary immunization by virtue of the entry of
a small amount of Rho(D)-positive fetal cells into
the Rho(D)-negative mother’s bloodstream.
Therefore, if a Rho(D)-negative mother has a
miscarriage, she should be considered as a
candidate for protective treatment with Rh-immune
globulin. Since the baby’s blood type might not be
known, one should assume that it was Rho(D)
positive, and extend passive antibody protection to
the mother within 72 hours of miscarriage.
Amniocentesis and other abdominal trauma
resulting in fetal cells entering the maternal
circulation are indications for Rh-immune
globulin.
• Since Rh antigens are fully developed in fetal cells
studied early in gestation, it is felt that an abortion may
also expose the mother to Rho(D) antigen, and in these
cases, Rh-immune globulin protection is recommended.
It may not be possible to determine the Rh of the fetal
cells, but even if the father is know to be heterozygous, it
is best to assume that the fetus is Rh positive.
• Contradictions: Rho(D)-immune globulin should not
be administered to an Rho(D)-positive individual or a
patient previously immunized to the Rho(D) blood
factor.