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.
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
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.