GENERAL INFORMATION, TEST DIRECTORY & ORDERING BLOOD COMPONENTS LOCATION & HOURS OF SERVICE

Registrations and Accreditations

• FDA Registration Number 1870530
• College of American Pathologists (CAP)
• Foundation for the Accreditation of Cellular Therapies (FACT)
• Transfusion Service accredited by the AABB (formerly known as the American Association of Blood Banks)
• Immunohematology Reference Laboratory accredited by the AABB

TEST DIRECTORY

Routine Pretransfusion Testing

• Required before issuing components for transfusion.
• Patient must be identified by a patient identification wristband and the wristband must remain on the patient.
• A sample used for Type and Screen is available for crossmatching for three days after submission.
• Regulatory agencies mandate that if the patient has been transfused or pregnant within the last three months, the blood sample used to perform pretransfusion testing must have been collected within three days of the transfusion. Samples used for crossmatching blood for patients known to have significant blood group antibodies must also be collected within three days of transfusion.
• A positive antibody screening test indicates possible sensitization to major red cell antigens outside the ABO system.
• Reflexive Testing: When unexpected reactions are detected in the antibody screening test, additional testing will be performed to determine the specificity of the antibody. Antigen typing of the patient and units may also be performed.
• A crossmatch must be performed before Red Blood Cells, Whole Blood, or Granulocytes can be transfused.
• Fresh Frozen Plasma, Platelets and Cryoprecipitate do not require crossmatching as they lack, or contain minimal, red cells. However, a blood sample may be required to determine the patient's ABO and Rh type.

• Pretransfusion testing prior to surgery or outpatient transfusion
• A preadmission sample may be collected up to one month prior to surgery if the patient does not have unexpected blood group antibodies and has not been transfused or pregnant within the last three months
• Samples collected for this program must be identified using an alphanumeric identifier provided on a PTS identification form.
• Upon admission, the patient must provide the identification form with the alphanumeric identifier to assure that the identity of the patient corresponds with the sample.
• PTS forms and additional information about this program may be obtained from the Blood Bank Main Laboratory 6-6888.

Prenatal, Postpartum and Pregnancy Related Studies

Use the Prenatal Studies Section of the Blood Bank Requisition.

NEWBORN INFANT STUDIES

Use the "Infant Studies" section of the Blood Bank Requisition

ANTIBODY STUDIES

Use the "Antibody Studies" section of the requisition

• Ordered to evaluate failure of platelet transfusions to raise the patient’s platelet count
• Post transfusion platelet counts are required.
• Contact the Blood Bank House Officer before collecting specimens.
• Collect specimens Monday-Thursday. Specimens collected on Friday, Saturday or Sunday cannot be tested.
• Specimens must be fresh.

Updated 9/20/11

Physician Responsibility for Identifying Patients with special Blood Requirements

Physicians must notify the Blood Bank of special patient needs such as:

• irradiated components
• volume reduced components
• CMV seronegative components
• recent transfusion history such as;
• blood group antibodies,
• recent transfusion at another hospital,
• recent exchange transfusion, or
• bone marrow transplant

Patients with Antibody Identification Cards

Patients may show staff members a card or letter listing red cell antibodies that may have been detected in their serum in the past, or give a history of past difficulties in obtaining compatible blood.

• Relay this information to Blood Bank personnel as soon as possible as this will assis in providing compatible blood for transfusions. Not all clinically significant antibodies remain detectable. Patients with a known history of clinically significant antibodies should be provided with antigen negative red blood cells.
• Even though all serological tests will be repeated in the Blood Bank information on prior immunohematologic studies may be invaluable.
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Collection and Submission of Blood Samples

Forms and Tube Labeling

Required on all requisition and specimen tubes:

• patient's full name
• patient's medical record number
• signature of the person collecting the blood sample

Additional Information Required on a Requisition

* current hospital location of the patient

* specific clinical indication for the transfusion

* where the component will be used - OR, dialysis, patient unit

* date and time the components are needed

* birth date

• The label should be placed going up and down the tube not flagged around the middle.
• The Phlebotomy Team will collect routine Blood Bank samples and additional samples required for resolution of serological problems on scheduled collection rounds.
• Samples for urgent requests for blood components and investigation of a possible hemolytic transfusion reaction should be collected by the unit personnel.

Positive Patient/Blood Sample Identification

It is impossible to overemphasize the importance of proper patient identification because inadequate or incorrect identification of patients is a common cause of serious complications associated with blood transfusion.

• Blood samples are not acceptable for testing if there ius any doubt about the accuracy of patient identification.
• Because name and birth date are not unique identification pair, blood samples for pretransfusion testing and blood components are labeled with the patients full name and University of Michigan CPI number.
• Unlabeled or misidentified samples will be discarded and a freshly drawn and appropriately labeled sample must be collected.
• When a sample is collected for pretransfusion testing, all patients including outpatients and those patients receiving off-site care, must have a positive patient identifier (PPI) such as an identification wrist band containing the patient’s name and medical record number. This PPI must be attached before the sample is collected.
• The patient should be instructed not to remove the PPI until after the transfusion is completed.
• For Preadmission Type and Screens the blue Patient Identification Form and the yellow numbered stickers serve as the PPI and links the specimen with the patient.
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Positive Patient Identification is required

* Ask the patient to state and spell his or her name each time a blood sample is collected.

* Confirm the patient's full name and registration number using the PPI.

* Label the blood sample tubes with the patient's full name and registration number before leaving the patient. The labels may be computer generated, hand written, or printed by addressograph plates.

* The blood sample labels must correspond with the identifying information on the patient's PPI and on the Blood Bank Requisition.

* CareLink: Sign the specimen (Minimum: first initial of first name and full last name) and complete the Collected By section in CareLink.

* Non-CareLink specimens: Initial and date the labels of all blood sample tubes and sign the requisition form. The initials on the sample tube and the "collected by" signature on the requisition identify the person responsible for the accuracy of the patient blood sample identification.

* Send completed requisition and appropriately labels specimen tubes to the Blood Bank together. If both tube and requisition are not received at the same time, the specimen must be recollected and sent with an appropriately completed requisition. 8/15/07

Identification of Unknown Patients

• If the patient's identity is unknown initially, a CPI number is assigned to the patient.
• The designation "Unknown #" with a number assigned such as "One Hundred Twenty Five" will be used as the name identifying the patient. This identification is used to label blood samples and requisitions.
• The PPI with the "Unknown" designation shall not be removed until the patient is admitted to a patient care unit.
• Blood crossmatched and labeled for the Unknown patient may be transfused to the patient even after the patient's true identity has been discovered, as long as the "Unknown" PPI remains on the patient.
• If the "Unknown" PPI is removed, a new blood sample with the patient's correct name and registration number, that matches the patient's current wristband, is required to provide blood components for transfusion.
• Name Change: When a patient’s name is changed as a protective measure, the initial PPI should not be removed until a new blood sample with the patient’s changed name and medical record number has been processed by the Blood Bank.

Volume To Be Collected

Adults: A full 6 mL blood sample in a pink top blood bank (EDTA) tube is required to perform a Type and Screen, and as to crossmatch multiple units of blood for most patients.

Children: A minimum of 2.0 mL of blood in a 6 mL pink top tube is required.

• Inadequate samples will require that additional blood be collected from the patient.
• A larger blood sample may be required when antibody identification studies are indicated.
• A physician on the patient's service will be notified if an antibody problem is encountered and if additional samples are required.
• Clotted blood samples and blood samples collected in serum separator ("Corvac" or "SST") tubes are unacceptable.
• If blood samples are collected from an anticoagulated catheter, a 1mL sample should be collected and discarded before the collection of the blood sample.
• Do not obtain blood samples from the tubing of an intravenous infusion set or draw from a vein in which an intravenous solution is flowing. Drugs and intravenous solutions can alter serologic reactions (e.g. dextran may cause rouleaux and false positive reactions and dilute samples so that incompatibilities cannot be detected).

TRANSPORT OF BLOOD SAMPLES

• Samples should be transported directly to the Blood Bank.
• They may be hand carried to the blood bank at UH 2F225 or sent using the pneumatic tube system (tube station E-2 or 224).
• Do not send sample to Central Distribution as this will delay receipt.

SAMPLE PROCESSING AND TURN-AROUND TIME

• If no difficulty is encountered in compatibility testing, routine orders for Red Blood Cells will be available within two hours after receipt of the order.
• An identified urgent need for blood or blood components will take priority over other blood orders. Notify the Blood Bank of the urgency of the request so that a priority can be assigned to the request.
• Notify the blood bank by telephone if a life threatening emergency exists and emergency transfusion is needed.
• Platelets, Fresh Frozen Plasma, Cryoprecipitate, and other components with storage limits of less than twenty-four (24) hours after preparation should be requested no more than one hour prior to the intended transfusion time.
• The Blood Bank will call the patient unit when components are ready for transfusion.
• Reserved Units
• Crossmatched units of red blood cells and other blood components will be held in the Blood Bank for a maximum of three days from the time the crossmatch sample was collected.
• The component reservations will be canceled at midnight. For example, if the Type & Screen sample was collected on the 4th day of the month at noon, any reservations for crossmatched units of blood would be canceled at 23:59 (11:59 pm) on the 7th.
• Unless approved by the Pathology House Officer, a maximum of two units of crossmatched red blood cells will be held for a patient. In most cases, additional units are available quickly and reservation of additional units is unnecessary.
• Staff members should notify Blood Bank personnel if the components reserved will no longer be needed so that they can be used for other patients.

Use of Non-Type Specific Components

Refer to the compatibility chart (on back cover of printed booklet).

ABO: In some circumstances it may be necessary to provide blood components that are not of the same ABO or Rh type as the patient. A common example of such a situation is the group AB patient who is given group A Red Blood Cells.

Rh: Rh positive blood may be supplied to an Rh negative patient with an immediate need for massive transfusion when sufficient Rh negative units are not available or when crossmatched or HLA matched single donor platelets are required. In such a setting, the risk of sensitization is outweighed by the need for blood. The Medical Director of the Blood Bank will review transfusions of Rh Positive components to Rh Negative patients  and will notify the patient's physician should Rh Immune Globulin be indicated.

Ordering Components

Orders may be submitted in CareLink, on a paper requisition sent via pneumatic tube or hand carried to the Blood Bank, faxed to the Blood Bank (6-6854) or ordered on "e-mail form".

If blood is needed urgently, call the blood bank (6-6888) and indicate the nature of the emergency. Request emergency release of blood components if blood products are needed before compatibility testing can be completed.

Written orders are required for routine orders. Emergency requests or add on requests from the operating room initiated by telephone must be followed up with a documented order.

To place an order to prepare components, provide the Blood Bank staff with the following information on a paper or electronic form:

• name and hospital registration number of the patient
• component and quantity required
• special requirements
• name or number of the ordering physician
• anticipated time of transfusion
• location of the patient
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If blood is needed urgently, call the blood bank and indicate the nature of the emergency. Request emergency release of blood components if blood products are needed before compatibility testing can be completed.

SPECIAL CONSIDERATION FOR TRANSFUSION OF INFANTS LESS THAN 4 MONTHS OLD

• Samples for pretransfusion testing should be collected in syringes and transferred into 6 mL pink top tube half filling the container. A minimum of 2.0 mL of blood is required.
• After the initial determination of ABO, Rh type and screening for unexpected blood group antibodies, it is not necessary to repeat these tests before the transfusion of most infants less than 4 months old. Consult with Blood Bank personnel before collecting additional samples from infants less than 4 months old.
• Due to the special needs of newborns, the Blood Bank provides partial units of Red Blood Cells and plasma in bags and syringes as well as single units of platelets prepared in syringes.
• When ordering components for these patients, indicate the volume to be transfused.

Revised 2/12/10