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 Ordering Blood Components and Laboratory Testing

RBCimage

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.

Ordering Blood Components

  • RBC Transfusion Guidelines
       Indications For Transfusing RBC's 
    Adult and Pediatric 
    Hemoglobin (Hgb) Concentration (g/dL)Patient Population/ Clinical
    < 7.0Non-Bleeding Medical and Surgical patients, including critically ill but clinically stable ICU patients
    < 7.5Patients 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 sActive Bleeding
    aPTT > 57 sSurgery 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

     

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 compatible
for 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.

Transfusion Services Quick Tools