Blood Bank Instructions.fm



Blood Bank InstructionsRequest and Release of Blood/Blood Components At the time of infusion, a “Blood Transfusion Record” must be completed for each unit of blood or component ordered. The “Blood Transfusion Record” prints in the Blood Bank and will be available at the time of issue.Split RBCs will only be separated immediately prior to administration. Washed RBCs must be ordered in advance of transfusion because they are washed at our Blood Center. Blood will be released only to Intravenous Therapy Technicians, RNs, LPNs, and CNAs.Exception: Surgery (main Operating Room [OR]/ Cardiovascular Operating Room [CVOR]) has trained orderlies for the release of blood and has a Blood Administration Policy unique for Surgery.Only 1 unit will be issued at each instance for 1 patient, unless an emergency situation exists where 2 units will be infused simultaneously to the same patient or during dialysis when the second unit is infused right after the first unit. The first unit is infused in approximately 15 to 20 minutes.Note: Under no circumstances can blood be simultaneously issued to 1 individual for 2 different patients.In an extreme emergency, the physician may not want to wait for completion of compatibility testing prior to release of the blood. In this situation, blood can be released immediately, but the physician must sign an “Emergency Transfusion Release” form. Even though an emergency situation exists, a “Blood Transfusion Record” must be completed. Since the testing is not complete, we cannot generate a computer “Blood Transfusion Record.” A preprinted “Blood Transfusion Record” (P-523) must be stamped with patient information and brought to the Blood Bank at issue. The crossmatch will be commenced immediately and the respective nursing station notified to stop the infusion of blood if any incompatibility is noted. Blood Bank results will be transmitted to the nursing service after crossmatch has been completed.Turnaround times for uncrossmatched and crossmatched blood are as follows:? An Emergency Transfusion Release for uncrossmatched blood requires an “Emergency Transfusion Release”form. Group O Rh-negative packed cells could be issued in approximately 5 to 10 minutes.? ABO and Rh type-specific blood requires an “Emergency Transfusion Release” form and a specimen to be drawn, processed, and typed. This request takes approximately 20 to 25 minutes.? A full crossmatch for blood takes approximately 50 to 65 minutes. This includes the time for the specimen to be drawn, processed, and crossmatched.? A type and screen takes approximately 40 to 50 minutes. This includes the time for the specimen to be drawn, processed, and tested.At any time, a type and screen can be converted to a crossmatch. The immediate spin crossmatch would take an additional 5 to 10 minutes, a full crossmatch will take an additional 20 to 25 minutes.These times are approximations and they vary due to emergency interruptions, equipment malfunction, different clotting times, difficulty encountered in drawing the patient, and available blood supply. If blood is needed sooner than anticipated, it will have to be taken as an Emergency Transfusion Release.Outpatient TransfusionOutpatient transfusions are performed in accordance with the standards that apply to inpatient transfusion. The transfusion is performed in 3C under medical supervision and the patient must be observed for an appropriate period of time after the transfusion. The patient is also instructed as to the occurrence of possible adverse reactions following the transfusion and is also given an information sheet, “Blood/Blood Component Transfusion,” by Nursing.A doctor’s prescription is required for any outpatient transfusion. Outpatient transfusions that qualify for Short Stay Care are scheduled through Central Scheduling in advance by the doctor’s office. Outpatient transfusions that are observation admissions will be scheduled through Central Registration. The Blood Bank must also be notified and given a copy of the prescription with the intended transfusion date. The prescription must indicate the diagnosis justifying thetransfusion and a hemogram, blood. It is recommended that another individual accompany the outpatient.Return/Storage of Unused Blood to Blood Bank Blood will be held in the Blood Bank refrigerator until time for administration.Exception: The only exception will be surgical patients whoseblood may be held in the OR or CVOR refrigerator.Blood cannot be held in any other refrigerator or at ambient temperature for more than 30 minutes. If initiation of infusion is unsuccessful, blood should be returned to the Blood Bank immediately, the reason should be documented in the laboratory information system. Once a unit has been returned to the Blood Bank, it will have to be signed out again, and a new “Blood Transfusion Record” completed if it is going to be infused.Transfusion ReactionsIf a reaction occurs, the transfusion should be stopped, the Blood Bank notified, the tubing clamped, and the attending physician notified for further instructions. Follow instructions on the “Transfusion Reaction” form. Order a “STAT” Transfusion Reaction workup in the computer so that a post reaction specimen will be drawn for Blood Bank to test. The blood bag, saline, and tubing must be returned to the Blood Bank, along with a completed “Transfusion Reaction Report” form. The type of reaction must also be noted on the “Blood Transfusion Record.” Two post-reaction urinalysis should be collected, and a bilirubin should be ordered 5 to 7 hours later. Care should be taken when discontinuing the blood to keep blood bag in sterile condition. When a transfusion reaction work-up has been completed by the Blood Bank and evaluated by 1 of the pathologists, 1 copy of the “Transfusion Reaction Report” form will be returned to the chart with the pathologist’s interpretation. The pathologist’s evaluation will also be documented on the patient’s report in the computer.Cancellation of BloodAll blood routinely ordered will be held for 48 hours and then automatically cancelled. Blood must be re-crossmatched after 48 hours with a fresh specimen.Exception: Pre-admit surgical patients requiring an ABO/Rh and antibody screening may have their blood drawn up to 14 days prior to surgery if they have not been pregnant or transfused within the last 3 months.Surgical Blood Order Schedule (SBOS)The SBOS is a list of the different operative procedures that require pre-operative testing from the blood bank. This list has been approved by the respective medical staff committees and administration. The SBOS serves as a guideline in estimating the needs for particular surgical procedures and should be consulted when pre-surgical testing is ordered. Variations dependent on patient history and medical condition are expected and therefore, this table is considered a guideline. If the physician’s orders exceed the SBOS, the orders will override the SBOS. Clinical judgment is required for procedures not listed on the SBOS. If a surgical procedure is not listed on the SBOS, pre-operative testing or blood may not be required.Cord Blood TestingAll newborns of mothers who have O-positive and Rh-negative blood will have a cord blood work-up performed. Cord blood work-up testing consists of an ABO and Rh typing, direct Coombs, and bilirubin (total and direct).All cord blood specimens will be brought to the Blood Bank and labeled with the mother’s addressograph information. The Nursery will order the required testing under the baby’s account number with an additional message of: CORD BLOOD, Mother’s MR # --------.Neonatal TransfusionIt is imperative that full information be available to the Blood Bank before blood is issued for neonatal transfusion. At the time before the blood is ordered, the Blood Bank will need to know if the requesting physician wants the blood to be <7 days old, cytomegalovirus-negative, irradiated, and to lack hemoglobin S. If prior work has not been done at Palos Community Hospital, duplicate reports of prenatal blood groupings, typing, antibody studies, and titers must be submitted to the Blood Bank well before the expected date of delivery so that suitable blood can be available. The mother’s blood specimen is used for crossmatching.Autologous Donation and TransfusionAutologous donation is the removal of one’s own blood to meet anticipated transfusion needs for planned, elective surgeries. A patient’s own blood is the safest blood that he/she can receive. The risk of exposure to blood-borne infectious diseases fromtransfusion is eliminated by transfusion of one’s own blood. Autologous blood may be the only suitable way to supply blood for patients who have rare blood types and/or multiple blood group antibodies. The patient may donate more than one unit provided they pass a mini-physical and meet established guidelines for autologous donations. The last donation should not be drawn within 72 hours of the scheduled surgery. Autologous blood can be stored in the refrigerator for 35 to 42 days and is reserved for the exclusive use of the patient. For a medically demonstrated need and the physician’s written request, the autologous red blood can be frozen and stored longer. Anyone wishing to become an autologous donor must have his/her physician complete a “Request for Autologous Donation” form. These forms are available in the physicians’ offices and the Blood Bank. The patient can then contact one of Heartland Blood Center’s drawing and distribution centers (Tinley Park) to schedule an appointment for his/her donations.Autologous donor units are subjected to the same tests as units drawn from other blood donors. After the units are processed, they are delivered to the hospital prior to the scheduled surgery date. The physician of the autologous donor is notified of any abnormal test results.Directed (Designated) DonationDirected donation is one in which patients select their own donors to met anticipated blood needs for planned surgeries or future scheduled transfusions. This type of donation is not intended to be used on an emergency basis.A “Request and Consent for Designated Donors” form must first be completed by the patient’s physician. These forms are available in the physician’s office and the Blood Bank. It is important that the patient’s blood type and Rh are known and recorded on the form. If the physician request directed donors for a patient, potential donors who are unaware of their type and Rh may have the tests performed at the hospital with an order from a physician. In most cases, patient and directed donor should be the same type and Rh unless noted otherwise on the form by the requesting physician. After this form has been completed, eligible donors should contact 1 of the Heartland Blood Center’s drawing and distribution centers (Tinley Park) to schedule on appointment for their donations. After collection, these units are subjected to the same tests as other donated blood. All directed products will be irradiated and leukoreduced. To allow ample time for collection, testing, processing, and delivery to the hospital, donors must donate at least 3 to 5, but not more than 12, working days (excluding Sundaysand holidays) before the date of surgery or intended use. Directed donor units are tagged specifically for the designated patient and held exclusively for that patient Once the hospital receives the directed donor unit, it is tested with the patient’s blood for compatibility. In most cases, there are no problems. However, if the directed blood cannot be used for the patient or fewer than the requested number of designated units are available, the patient’s physician will be contacted. The donors will be notified of any abnormal test results. Directed donors are irradiated.Intraoperative Autotransfusion (Cell Saver) Surgery manages and coordinates procedures and the Blood Bank supervisor/technologists supervise the quality assurance for the Intraoperative Autotransfusion Program utilizing an automated cell saver system. Blood that is shed during or after a surgical procedure is salvaged, processed, and returned to the patient in an attempt to diminish the patient’s exposure tohomologous blood products.Coverage is provided by an outside service.Leukocyte Reduced (Prestorage) Blood Products All RBCs and pheresed platelets are prestorage leukoreduced. Regardless if the physician orders them or not, our blood center will provide prestorage leukoreduced RBCs and pheresed platelets. Nursing is to include any other requirements (cytomegalovirus negative, irradiated) with the order.Leukocyte Removal FiltersLeukocyte removal filters are available in the Blood Bank forRBCs and pheresed platelets that are not leukoreduced. When nursing picks up the blood, the leukocyte removal filter will be dispensed also. Leukocyte removal filters for RBCs and pheresed platelets will be available in the event of unavailability of prestorage leukoreduced RBCs and pheresed platelets.Rh-Immune GlobulinRh-Immune globulin is used to prevent the formation of activeantibodies in the Rho(D) negative, individual who has received Rh(D)-positive RBCs. Exposure to Rh-positive RBCs can occur as a consequence of pregnancy, abortion, delivery, or transfusion of an Rh-negative recipient with Rh-positive RBCs.Abortion, either spontaneous or induced, ectopic pregnancy, abdominal trauma, and amniocentesis may cause fetal-maternal hemorrhage.Any female patient within this category must have an Rh- immune globulin profile performed to determine whether or not she is an Rh-immune globulin candidate. If Rh-immune globulin is administered antepartum, it is essential that the mother receive another dose of Rh-immune globulin after delivering a Rho(D)-positive or Du-positive (weak D) infant. Rh-immune globulin should be administered intramuscularly within 72 hours. The patient should be given an Rh-immune globulin booklet to read and an identification card to carry. If the patient has received Rh-immune globulin antepartum, it is very important that the hospital Blood Bank be notified with this information prior to delivery.Additional Information:? Antepartum mother should meet the following criteria in order to be considered a candidate for Rh- immunoglobulin.? Mother must be Rho(D) negative.— The mother must not already be immunized to theRho(D) factor.? Postpartum mother should meet the following criteria in order to be considered a candidate for Rh-immune globulin:— Mother must be Rho(D) negative.— Mother must not already be immunized to the Rho(D) factor. If the mother was given Rh-immune globulin antepartum (28 weeks), passive antibody may be detected in the mother’s serum up to 3 months following the injection. It is important to know if the mother has received Rh-immune globulin antepartum so that laboratory tests can be interpreted correctly. (Passive antibody is not stronger than a 1:4 dilution.)— Mother’s baby must be Rho(D) positive or Du positive (weak D).— Mother’s baby should have negative directCoombs’s test.? A positive direct Coomb’s test of the cord blood does not of itself preclude the administration of immune globulin. The direct Coomb’s may be positive for 1 of the following reasons:— Mother is immunized to Rho(D) and prenatal tests were in error, were not done, or were not reported.— Mother is immunized to a factor other than Rho(D)and the baby is positive for that factor.— Mother and baby are ABO incompatible and the baby’s cells have absorbed the antagonistic maternal antibody of the ABO system. Rh-immune globulin should be administered to an Rh-negative woman if the baby is Rh positive even though the direct Coomb’s test is positive, presumably due to ABO incompatibility.— Baby may have a positive direct Coomb’s due to passive antibody if the mother was given prophylaxis (28 weeks).? Rh-immune globulin must be given within 72 hours after delivery for complete protection. With each delivery opportunity for exposure to fetal cells is repeated. The protection given at the delivery of the first baby does not protect the mother from exposure to antigen received at a later time; hence, Rho(D)-immune globulin must be given immediately following each pregnancy.— It has been suggested that a miscarriage can serve as a primary immunization by virtue of the entry of a small amount of Rho(D)-positive fetal cells into the Rho(D)-negative mother’s bloodstream. Therefore, if a Rho(D)-negative mother has a miscarriage, she should be considered as a candidate for protective treatment with Rh-immune globulin. Since the baby’s blood type might not be known, one should assume that it was Rho(D) positive, and extend passive antibody protection to the mother within 72 hours of miscarriage. Amniocentesis and other abdominal trauma resulting in fetal cells entering the maternal circulation are indications for Rh-immuneglobulin.? Since Rh antigens are fully developed in fetal cells studied early in gestation, it is felt that an abortion may also expose the mother to Rho(D) antigen, and in these cases, Rh-immune globulin protection is recommended. It may not be possible to determine the Rh of the fetal cells, but even if the father is know to be heterozygous, it is best to assume that the fetus is Rh positive.? Contradictions: Rho(D)-immune globulin should not be administered to an Rho(D)-positive individual or a patient previously immunized to the Rho(D) blood factor. ................
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