1.7 - Blood Bank General Information

IMMUNOHEMATOLOGY (BLOOD BANK)
TRANSFUSION MEDICINE

Technical Director of Blood Bank

Hongbo Yu, MD

857-203-5898

BACL Blood Bank Supervisor

West Roxbury

Kirsten Torkelson

857-203-5968

Laboratory Telephones

West Roxbury

857-203-5966

GENERAL
 
Blood Bank Policy Memorandum gives a detailed statement of the Laboratory Service policy for the transfusion of blood and blood products.  A summary of the policy is given below.
 

BLOOD BANK SPECIMEN COLLECTION
 
Most blood bank tests, i.e., type and screen, type and cross require a 6 ml plastic EDTA (plasma) pink top tube.  For transfusion reaction work-ups, a post-transfusion 6 ml plastic EDTA (plasma) pink top tube is needed plus urine specimen.  Direct antiglobulin tests (DAT) are done on 6 ml plastic EDTA (plasma) pink top tubes.  All specimens must be free of hemolysis.   Incorrectly or incompletely labeled specimens will be discarded.
 
Blood Bank specimen requirements are stricter than most clinical laboratory departments.  Blood bank specimens may be drawn by individuals who are in the following categories: employed by the VA, in VA training programs, or are VA contracted employees working within a VA facility.  Blood bank specimens cannot be collected by individuals at non VA staffed drawing stations (e.g. Quincy lab, Quest Framingham Drawing Station).Note: Bedford patients requiring transfusion are transferred to another VA facility. Blood Bank specimens should not be drawn at the Bedford VAMC(unless the patient is properly wristbanded). The Bedford lab discourages obtaining a blood bank specimen before the patient is transferred. (However, if the sample is properly labeled and collected per BACL policy the WROX lab will accept the specimen.)


BLOOD BANK SPECIMEN IDENTIFICATION

Procedure for verifying patient identity is mandatory, failure to verify patient identity may result in the incorrect person's specimen being drawn and raises the likelihood of a fatal hemolytic transfusion reaction.

1. Ask the person to state their name and social security number, if they are unable to respond you must ask a nurse or physician to positively identify the person.  The nurse or physician then will cosign the specimen tube.
2. The patient's wrist band must be checked.  Verify the patient's complete name, complete social security number with information on the tube label/orders/blood bank specimen collection form.  In the event of discrepancy do not draw the patient.  A staff member is to be notified and the discrepancy is to be resolved.  A new wrist band with the correction is to be placed on the patient before the specimen is drawn.
3. Patients without wrist bands must not be drawn for any specimens to be submitted to the Blood Bank.
4. All specimens must be promptly labeled, in the presence of the patient being drawn.  Do not leave the patient you have positively identified without labeling the specimen.  The specimen must bear complete  Social Security #; First and Last Name; date drawn; and the full signature of the person who drew the specimen and verified the patient identity.
5. Once the specimen is labeled, recheck that you have placed the correct label on the tube.  Check the tube label against the wrist band.

The blood specimen with the blood bank specimen collection form will be forwarded directly to the Blood Bank without delay.
Blood products are ordered by entering an order in CPRS GUI.


PRE-TRANSFUSION TESTING

Grouping, typing, antibody screening and compatibility testing will be performed in accordance with established procedures.


EMERGENCY TRANSFUSIONS

In life threatening situations where time does not permit complete pre-transfusion testing, blood may be released from the Blood Bank if the requesting physician assumes full responsibility and signs an emergency release form.  He should be fully aware that the patient is receiving blood that is uncrossmatched and/or before the patient is tested for the presence of irregular antibodies.  The blood bank will complete the work as soon as possible.


ISSUING AND RECEIVING OF BLOOD
 

1. In all instances involving the issue of a unit of blood for transfusion from Laboratory Service, a member of the Laboratory Service staff shall see that the special CAUTION TAG (VA Form 10‑2084) is securely attached to the unit and the blood transfusion record form(BTRF) is placed in the same biobag or cooler as the unit before it leaves the Laboratory Service.  Only authorized personnel may issue blood units from the Blood Bank and only to authorized personnel.  The date and time of issue and the name of the person taking the blood shall be recorded.  Only one unit of red cells will be released at a time, except in emergencies, and/or for the OR, SICU, MICU and CCU.  Only red cells on one patient may be picked up by the same person at the same time except for the OR and SICU.
2. Blood administration will begin within 30 minutes from the time it is released from the Blood Bank.  Blood may not be stored in refrigerators outside the Blood Bank.  Ward refrigerators do not have adequate temperature controls/monitors  and must not be used for storage of blood.  Any unit that has been issued from the Blood Bank for more than 30 minutes and/or its temperature has exceeded 10 degrees Celsius cannot be accepted for reissue.  Blood transfusion time must not exceed 4 hours.
3. Following the completion of the transfusion, blood transfusion record form (BTRF) must be returned to the Blood Bank.  The blood bag is not to be returned to the blood Bank except in cases of suspected transfusion reactions.

CANCELLATION OF CROSSMATCH
 

1. The Lab should be informed of canceled cross-matches as soon as possible.
2. Samples used for compatibility testing must be drawn within 3 days of the transfusion. Day 0 is the day of draw. Example, specimen drawn on Monday is valid to use for any transfusion on Monday, Tuesday, Wednesday or Thursday.
3. Cross-matched units may be held and considered available for transfusion up to the end of the specimen's life span.  However, units may be released into the general inventory at the discretion of the Blood Bank and hence the units may be unavailable for the patient.  Some events which necessitate units being released include:
   1. Change in patient transfusion requirements.
   2. Patient's surgery is rescheduled or canceled.
   3. Inventory management.
   Once units reserved for a particular patient are released, a new order for blood products must be implemented (consult Blood Bank for specimen requirements).

TRANSFUSION PROCEDURES

The physician will assume the responsibility for providing close supervision of the patient until the transfusion is finished.  The blood transfusion record form will be returned to Blood Bank.  Do not return the blood bag to Blood Bank unless a transfusion reaction is suspected.  Remember to complete the Pretransfusion Data and Transfusion Data section of the blood transfusion record form.


TRANSFUSION REACTIONS

1. If transfusion difficulties occur, the physician administering the blood will immediately discontinue the transfusion.  He will promptly notify the Blood Bank and will also complete the Transfusion Reaction Data section of the blood transfusion record form (BTRF).  The suspected blood bag unit, the required specimens and the BTRF must be returned to the Blood Bank to initiate the work-up. A Suspected Transfusion Reaction consult will be entered using CPRS GUI.
2. The Laboratory Service will investigate the reported transfusion reaction following the procedures prescribed by the American Association of Blood Banks.  In order to investigate the transfusion reaction.  It will be necessary to obtain a post transfusion 6 ml plastic EDTA (plasma) pink top tube and urine specimen.
3. The Blood Bank Pathologist will administratively complete the Suspected Transfusion Reaction consult.  No further red cell products may be issued until completion of the transfusion reaction work-up.  If blood is needed for life threatening conditions prior to completion of the transfusion reaction work-up, units will be issued only after an emergency release form is signed by the physician or house officer.

BLOOD BANK INVENTORY

The Blood Bank inventory consists of Babesia negative leukoreduced packed red cells, Babesia negative leukoreduced Irradiated CMV negative packed red cells, fresh frozen plasma, pooled cryoprecipitate, and a small standing order of platelet apheresis units. If our standing order platelet apheresis unit has been assigned or transfused a replacement unit will only be ordered from the American Red Cross if we receive an order to transfuse platelets. Platelet apheresis units have a short shelf life and cannot be returned to the American Red Cross if not used, so only order if transfusion is definite.   

Blood Bank Notification	Time Required
Leukoreduced Packed RBC (Babesia negative)	X-match Turnaround Times: STAT  45 minutes ASAP/Routine 1-2 hours 15 minutes if typed and screened specimen available on a patient without antibody problems
Washed RBC	24 Hour notice Approval required
Fresh Frozen Plasma	45 minutes before use: Notify Blood Bank to implement “Request to Thaw”
Platelets	Small standing order inhouse for emergencies. If more than 1 units is needed in a day additional productmust be ordered from Red Cross Dedham Short expiration time and cannot be returned to ARC
Leuko Depleted Products	X-Match Turnaround time: STAT 45 minutes ASAP/Routine 1-2 hours 15 minutes if typed and screened specimen available on a patient without antibody problems
Irradiated or CMV tested products (Babesia negative)	Small stock keep in house for emergencies.  Additional units must be ordered from the American Red Cross.  Allow a minimum of three hours for orders of more than two units.

BLOOD PRODUCTS
 

Product		Shelf Life	Volume	Indications for Use
Red Blood Cells, Leukocytes Reduced		42 Days	250 mL	Increase Oxygen carrying to tissue Red Cell replacement
Deglycerolized Red Blood Cells		24 Hours	230 mL	Red Cell Replacement when: Rare blood is needed Patient has antibodies Leukodepleted product needed No residual plasma for IgA deficient recipient
Washed Red Blood Cells		24 Hours	200 mL	Repeated febrile Transfusion reactions Repeated, severe hypersensitivity reaction to plasma proteins
Apheresis Platelets Leukocytes Reduced		5 Days or less	200-400 mL	Platelet replacement in patients (Platelet Pheresis) with low counts or dysfunctional platelets
Pheresis Platelets Leukocytes Reduced PAS (Platelet Additive Solution)		5 Days or less	200-400 mL
Platelet Psoralen Treated PAS (PR-Pathogen Reduced		5 Days or less	200-400 mL
Fresh Frozen Plasma		24 Hours(once thawed)	200 mL	Replacement of clotting factors
Pooled Cryoprecipitate AHF		6 Hours (once thawed)	25 - 100 mL	Von Willebrands Disease Replacement of Factor VIII or fibrinogen in hemophilia, surgical patients with coagulopathy, DIC

Blood Bank