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 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
    < 7.0Non-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)

    • Platelet dysfunction (documented aspirin)

    • Massive hemorrhage


Transfusion Related Laboratory Orders


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.


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