Ordering Blood Components and Laboratory Testing
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 < 7.0 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
On anticoagulation prophylaxis (e.g. heparin, DOAC, etc.)
Immediately prior to low risk invasive procedures, including but not limited to:
Temporary non-tunneled venous access insertion and removal including PICC lines
Peripheral arterial line
Bone marrow biopsy
About to be discharged
- Immediately prior or during high-risk procedures such as those listed in JVIR guidance.
CNS or retinal bleed
Bleeding due to platelet dysfunction not responsive to DDAVP or Cryo (must consult Transfusion Medicine Physician)
Platelet dysfunction (documented aspirin)
Transfusion Related Laboratory Orders
TYPE & SCREEN
Type and Screens are a pre-transfusion laboratory test that consist of:
- ABO/RH Identification
- Antibody Screen
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.
- 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
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 SpecimenThe 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.