Ordering Blood Components and Laboratory Testing
NOTICE:
Blood and blood components must be ordered by a Licensed Independent Practitioner (LIP) such as a physician or nurse practitioner. Transfusions should only be prescribed for a patient when the benefit of transfusion is likely to outweigh the risk.
See link below for Transfusion Services STAT Turn Around Times.
-
RBC Transfusion Guidelines
Indications For Transfusing RBC's Adult and Pediatric Hemoglobin (Hgb) Concentration (g/dL) Patient Population/ Clinical < 7.0 Non-Bleeding Medical and Surgical patients, including critically ill but clinically stable ICU patients < 7.5 Patients undergoing cardiac surgery < 8.0 Patients with Acute Coronary Syndrome, Patients with hip fracture and cardiovascular disease and Hemodynamically stable patients with acute GI bleeding
-
Plasma Transfusion Guidelines
Indications For Transfusing Plasma With at least 1 of the following: Patient Population/ Clinical PT > 20 s Active Bleeding aPTT > 57 s Surgery or Invasive Procedure Specific Clotting factor deficiency < 26% of normal and no other product available Dilutional Coagulopathy (i.e. Massive Transfusion)
-
Platelet Transfusion Guidelines
Indications for Transfusing Platelets: Laboratory and Clinical Platelet Concentration (K/μL) Patient Population/ Clinical < 10 - Clinically stable non-bleeding inpatients
< 20 Inpatients
On anticoagulation prophylaxis (e.g. heparin, DOAC, etc.)
Immediately prior to low risk invasive procedures, including but not limited to:
Thoracentesis
Temporary non-tunneled venous access insertion and removal including PICC lines
Peripheral arterial line
Bone marrow biopsy
About to be discharged
Outpatients
< 50 Active bleed
Lumbar Puncture
- Immediately prior or during high-risk procedures such as those listed in JVIR guidance.
< 100 Neurosurgical patients
CNS or retinal bleed
Bleeding due to platelet dysfunction not responsive to DDAVP or Cryo (must consult Transfusion Medicine Physician)
Any Platelet dysfunction (documented aspirin)
Massive hemorrhage
-
Component TAT
PRODUCT PROCEDURE PRE-REQUISITE TAT Type and Screen
Receipt of acceptable specimen; Negative Antibody Screen and No History of Antibody*
60 minutes
ABORh Confirmation
Receipt of acceptable specimen
30 minutes
Crossmatch
(Red Blood Cells)
Receipt of acceptable specimen; Complete Type and Screen with Negative Antibody Screen and No History of Antibody ** Complete 2nd ABO/Rh Confirmation
15 minutes
Crossmatch additional units
Receipt of acceptable specimen; Complete Type and Screen with Negative Antibody Screen and No History of Antibody ** Complete 2nd ABO/Rh Confirmation
15 minutes
Uncrossmatched RBCs –
O Negative
Verbal confirmation that physician will sign waiver; collection of specimen
10 minutes
Uncrossmatched RBCs –
Type Specific
Verbal confirmation that physician will sign waiver; Receipt of specimen and 2nd ABO/Rh Confirmation
10 minutes
Fresh Frozen Plasma
Blood type on record for current admission
30 minutes
If no blood type on record on current admission and receipt of acceptable specimen.
1 hour
Platelets
Blood type on record for current admission
15 minutes
If no blood type on record on current admission and receipt of acceptable specimen.
1 hour
Cryoprecipitate (pooled)
Blood type on record for current admission
15 minutes
If no blood type on record on current admission and receipt of acceptable specimen.
1 hour
*All TATs dependent on availability of blood component.
Special transfusion requirements (ex.: CMV negative, Irradiated, Hgb S negative, will lengthen TAT).
**If antibody screen in positive, TAT dependent on complexity of antibody ID.
Transfusion Related Laboratory Orders
TYPE & SCREEN
Type and Screens are a pre-transfusion laboratory test that consist of:
- ABO/RH Identification
- Antibody Screen
Two ABO/RH identifications MUST be on file to obtain blood components. Otherwise, emergency units and an
emergency release waiver will be needed.
Having a T&S ready and available for patients who may need a transfusion allows for quicker dispensing of necessary blood component when the need is determined.
Note:
If the antibody screen is positive there will be an inherent delay to find the correct component that is compatiblefor the patient. The delay can range from 1-2 hours or possibly even days depending on the complexity.
Specimen Requirements:
- All requests must include requesting physician's name and ID number, patient's complete name, UH number, current account number, patient location, clinical information/diagnosis, identity of phlebotomist and verifier, and date/time of sample collection.
- The specimen must be labeled with the patient's full name and UH number. Specimens should be transported to the laboratory in a biohazard specimen bag with the request form in the pocket of the bag. All information must be complete and legible on the specimen and the requisition.
Causes for Specimen Rejection
- No label on tube
- Incorrect or incomplete patient identifiers
- Incorrect or incomplete collection information
- Wrong tube type
- Gross hemolysis
- Diluted specimen
- QNS
NOTE- If a specimen is rejected; a Blood Bank technologist will contact the nurse or physician of the rejection and need for re-collection.
Expiration of The Specimen
The expiration of a compatibility specimen only applies to Packed Red Blood Cells (PRBCS).- For adults: the specimen expires 3 days after the specimen was collected. For example, if the sample was collected on Tuesday, it would expire Friday at 23:59.
- For infants ≥ 4 months of age, the expiration of the compatibility specimen follows the same principle as adults.
- For infants < 4 months expires when the infant turns 4 months of age.
