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LOCATION AND SERVICE HOURS

Function	Location	Phone	Scheduled Hours
Blood Bank	C271 GH	6-2561	24 hours
Blood Donor Center: Blood Donation	C250 GH	6-2058	Call for current hours of operation
Blood Donor Center: Patient Services	C250 GH	6-3710	0800-1700 weekdays
Consultation	Pathology Resident	Pager 3404	24 hours
Tissue and Cellular Therapies:   Hematopoietic Progenitor Cell (HPC) Lab	C271 GH	4-5292	0800-1630 weekdays
Tissue and Cellular Therapies: Tissue Bank	C271 GH	6-3709	24 hours

BLOOD AND BLOOD COMPONENTS

Available Blood Components

The DeGowin Blood Center maintains an inventory of Red Blood Cells, Plasma, Single Donor (apheresis) Platelets, and Cryoprecipitate. Granulocytes are available by special request. All Red Blood Cells and Platelets are leukocyte-reduced, and are considered equivalent to CMV-seronegative. Cellular components can be irradiated or washed upon request or as indicated by established protocol.

Please refer to the UI Hospitals and Clinics Policies and Procedures web site for Transfusion Protocols - DeGowin Blood Center.

Transportation

Blood components (except for Granulocytes) can be transported to the patient care areas via the pneumatic tube system. This method of transport is used when transfusion is immediate, or when there is an approved blood refrigerator on the patient care area. When blood components are requested for possible use in an area without a blood refrigerator, approved transport containers (coolers) are available for pick up from the Blood Bank.

Storage Temperature

Blood components should be transfused or returned to Blood Bank immediately, unless one of the following applies:

• Red Blood Cells and Plasma may be stored in an approved blood refrigerator, or an approved transport container (cooler) obtained from Blood Bank.
• Platelets, Cryoprecipiate and Granulocytes must be kept at room temperature – NEVER REFRIGERATED

The Circular of Information for the use of Human Blood and Blood Components is considered an extension of blood and blood component container labels as the space on those labels is limited. The Circular of Information contains sections on general information, side effects and hazards of transfusion, blood components descriptions, actions, indications, contraindications, dosage and administration. The circular was prepared jointly by the AABB, America’s Blood Centers and the American Red Cross, and is recognized as acceptable by the Food and Drug Administration.


PRETRANSFUSION COMPATIBILITY TESTING

Type and Screen

Type and Screen is appropriate for all patients who are unlikely (<25% chance) to actually need a transfusion, but may need blood to be available promptly if a need arises. A blood type (ABO and Rh) and antibody screen will be performed. The antibody screen detects the presence of clinically significant Red Blood Cell alloantibodies in the recipient's plasma. The sample is stored in the blood bank and is valid for crossmatching three days after collection. (e.g., the date the sample is drawn + three days. A sample collected on Monday is good until midnight on Thursday.)

If additional (reflex) testing is necessary to provide ordered blood components, the testing WILL BE performed unless indicated in Epic or a signature is present on the Blood Center Request form A-1a to prohibit it.

Crossmatch

If a Type and Screen has been ordered, and blood is subsequently needed, it may be requested by placing an order in Epic or sending an A-1a Blood Center request. If the patient's current and previous antibody screens are negative, an electronic crossmatch is performed to detect ABO incompatibility only. The Red Blood Cell unit is then available within 15 minutes. Returned units are not held for a given patient.

When a patient has a clinically significant antibody, an antiglobulin crossmatch is performed and the donor’s cells are tested for the corresponding antigen. This takes 45 minutes or greater. Crossmatched units of blood are held for a given patient until the sample has expired (three days after the day of collection).


HOLD GUIDELINES FOR PRETRANSFUSION COMPATIBILITY TESTING

DeGowin Blood Center Transfusion policy BC-475.11: Hold - Pretransfusion Compatibility Testing Specimen Guidelines


TRANSFUSION ORDER REQUIREMENTS
A transfusion treatment is defined as the infusion of blood product(s) to fulfill a single clinical indication. One or more units may be needed to provide the correct dose for each single event. It is against hospital policy to write standing orders for transfusion. The patient should be evaluated at least once daily, and new transfusion orders written as needed. A licensed independent practitioner (LIP) order must be placed in the medical record for each transfusion event. The only exception is during surgery when the order may be written on the anesthesiology record.

Each order must include the name of the product, special instructions (e.g., irradiated, washed, autologous), the volume or the number of units, and the total administration time or rate of infusion.  An order for transfusion may be based on specific objective parameters, and may be written for more than one unit of a blood product (e.g., "If hemoglobin is <7 gm/dL, transfuse two units Red Blood cells over six hours").   Each transfusion treatment requires a separate order. Special requirements (such as irradiated, washed or autologous) should be noted.

The DeGowin Blood Center may issue a blood component different than that ordered when indicated by patient needs or University of Iowa Hospitals and Clinics policies.


PRETRANSFUSION SPECIAL TESTING ORDER
A special order can be made in advance for patients who have planned transfusions and known red cell antibodies, special antigen needs, are refractory to platelets transfusions, or have blood allergies (e.g. anti-IgA).

Placing this order in advance allows the Blood Bank to make arrangements to locate hard to find or unusual blood components and to avoid transfusion delays.


INFORMED CONSENT
It is the University of Iowa Hospitals and Clinics policy RI-PR-05.07 to obtain informed consent before transfusing blood components in nonemergency settings. Two of our accrediting agencies, the AABB, and The Joint Commission, note the need for informed consent prior to blood transfusions in their accreditation manuals. Members of the Transfusion Subcommittee have approved four methods to facilitate obtaining informed consent before blood transfusions. They are as follows:

1. Form G-2d₂ - "Consent for Blood Transfusion" can be completed and placed in the patient's medical record. This form is available in Hospital Stores (stock number 923463).

2. Form G-2d₂ - "Consent for Operation or Procedure" includes a brief statement regarding transfusion of blood products. This form is available in Hospital Stores (stock number 922373).

3. Form G-2d₁₃ - "Consent for Therapeutic Apheresis" includes statements regarding transfusion of blood products when needed as replacement for blood components removed by apheresis procedures. This form is used exclusively by the DeGowin Blood Center.

4. Form G-2d₂ - "Consent to Collect Lymphocytes and/or Peripheral Blood Progenitor (Stem) Cells by Automated or Manual Methods", include statements regarding potential for Red Blood Cell prime of the circuit in small pediatric patients and is only used by the DeGowin Blood Center.

Consent does not have to be obtained before each individual transfusion of blood or blood products but should be obtained when management decisions are made (e.g. at the time of the initial decision to transfuse and at the time of any change in the patient's condition and treatment plan that changes risks, benefits, or indications for transfusion). For inpatient transfusions, consent will be valid no longer than that hospitalization. For outpatient transfusions, the consent may be valid for up to one year.

Blood transfusion consents are scanned into Epic and are available in the Chart Review Media tab.


BLOOD CENTER REQUISITION AND SPECIMEN COLLECTION

Refer to the following policies

Surgical Services policy SS-10.005: Blood Specimen Collection and Administration in the Operating Room

Nursing policy N-07.069: Blood Specimen Collection for Type and Screen and All Blood Bank Samples

Nursing policy N-07.070: Blood and Blood Components using Scanned/Barcode Technology, Administration of

Nursing policy N-07.072: DOWNTIME PROCESS: Blood Product Tracking

Patient identification on the specimen label and the requisition must be legible and complete.  (The date of collection should be on the specimen label).  The patient identification on the specimen and the requisition must match.  Specimens that are not collected as specified in the above UIHC policies cannot be accepted.  Specimens that are unlabeled, illegible or incomplete, or specimens that do not match the requisition cannot be accepted.  Unacceptable samples must be discarded and will need to be recollected.

The requisition must include the physician's name and code number and collection date/time. Indicate the tests and/or or blood components needed, and the date/time needed.  Special requirements (such as irradiated, washed or autologous) should be noted, as well as additional information for obstetric and pediatric patients.


EMERGENCY ISSUE OF BLOOD

For patients of unknown/undetermined ABO/Rh group, group O Red Blood Cells (RBCs) available in the following locations for emergency transfusion:

Location and Number of Units	Action Required by Ordering Physician
Emergency Department (ED) 4 units RBCs, O Rh Negative (intended for females) 4 units RBCs, O Rh positive (intended for males) NOTE: the ordering physician is responsible for selecting the appropriate Rh type	Complete the Emergency Transfusion Requisition (attached to the unit), sign and send to the Blood Bank Complete an Epic ED/CCL Blood Admin (0-/0+ Floor Stock) Order
Critical Care Laboratory (CCL) 4 units RBCs, O Rh negative (intended for females or males)	Complete the Emergency Transfusion Requisition (attached to the unit), sign and send to the Blood Bank Complete an Epic ED/CCL Blood Admin (0-/0+ Floor Stock) Order
Main Blood Bank (BBM) Inventory of RBCs, O Rh negative and O Rh positive	Complete an Epic order denoting "Emergency" in the order or complete the Pathology A1-a Pathology Doctor’s Order Blood Center Request with Emergency Release box and the order for Red Cells

Blood Bank must have a current (within 3 days) blood specimen for blood type. Reliance on previous records to obtain a blood type is not permissible. Blood Bank does not delay emergency issue to wait for paperwork.

Group O RBCs are issued for patients whose ABO/Rh is unknown (e.g. there is no current blood sample available or there is insufficient time to determine ABO/Rh type before blood is needed).

ABO type-specific and Rh type-compatible RBCs are issued for patients whose ABO/Rh is known (e.g. time is available to perform the type on an acceptable pretransfusion compatibility testing sample).

ABO type-specific and Rh type-compatible, antigen negative RBCs are issued for patients whose ABO/Rh and antibody history is known (e.g. pretransfusion compatibility testing completed, no time to antigen test/crossmatch blood).


BLOOD ADMINISTRATION

Before sending for blood, the transfusionist should ensure that venous access has been established. 

Refer to the following policies

Nursing policy N-07.070: Blood and Blood Components using Scanned/Barcode Technology, Administration of

Surgical Services policy SS-10.005: Blood Specimen Collection and Administration in the Operating Room

Nursing policy N-07.072: DOWNTIME PROCESS: Blood Product Tracking

Acceptable for use with transfusion	Comment
0.9% saline	Only solution approved for direct mixing with blood
5% dextrose in 0.9% saline	Approved for rinsing I.V. tubing
5% dextrose in 0.45% saline	Approved for rinsing I.V. tubing

Unacceptable with transfusion	Reason
5% dextrose in water	RBC Clumping and hemolysis
5% dextrose in 0.2% saline	RBC Clumping and hemolysis
Lactated Ringer's solution	Clotting
Any other solutions	RBC Clumping and hemolysis

Immediately before starting the blood transfusion, gently mix the blood unit by gentle inversion. Administration instructions are printed on the label of each unit. Note: Do not mix containers of blood components together prior to transfusion.

Use of blood filters:

Refer to the Nursing policy N-07.070: Blood and Blood Components using Scanned/Barcode Technology, Administration of


TRANSFUSING INCOMPATIBLE RED BLOOD CELLS

On rare occasions it may not be possible for the Blood Bank to provide Red Blood Cells that are serologically compatible with the recipient. The Blood Center physician will inform the patient's physician when a new incompatibility is identified. Accompanying each unit of RBCs will be a copy of the Information for Patient Care Staff Transfusing Incompatible Red Blood Cells form for reference. Please refer to DeGowin Blood Center Transfusion policy BC-475.15: Protocol for Transfusing Incompatible Red Blood Cells.

Start the transfusion slowly

• If patient condition permits, start the transfusion slowly at one ml per minute for the first 15 minutes.
• Observe the patient constantly for symptoms and signs of a reaction.
• Take vital signs prior to starting transfusion, whenever a reaction is suspected or, in the absence of a reaction, after the first 15 minutes, after 30 minutes, and after completion of transfusion.

If there is evidence of a transfusion reaction

• See Adverse Reactions to Transfusion.
• If patient condition warrants immediate transfusion:

• Begin another unit of Red Blood Cells per physician order. The new unit also is likely to test as incompatible, but may be tolerated better.
• If further transfusions can be delayed, follow the transfusion reaction policy and resume transfusion after evaluation is complete.
• Page the Blood Center resident (pager 3404) to discuss options.

If no symptoms or signs of transfusion reaction are noted after 30 minutes

• Proceed with the transfusion and monitor the patient per usual transfusion practices.
• Repeat the entire process for each incompatible Red Blood Cell unit transfused.

ADVERSE REACTIONS TO TRANSFUSION

• Symptoms may include fever, pain, apprehension, chills, sweating, tachycardia, tachypnea, decrease in oxygen saturation, or fall in blood pressure.
• STOP the transfusion immediately, maintaining the IV with 0.9% saline.
• Refer to Nursing policy 07.070 Blood and Blood Components using Scanned/Barcode Technology, Administration of.

BACTERIA DETECTION TESTS

Apheresis platelets are cultured for evidence of bacterial contamination. Cultures may take several days for results. Positive cultures will be reported as soon as possible to the appropriate clinical service. If a patient develops signs and symptoms consistent with bacteremia or sepsis after transfusion, the clinical service should initiate investigation of suspected adverse reaction to transfusion. Refer to Adverse Reactions To Transfusion section above.


PATIENT SERVICES

The services listed below are available in the DeGowin Blood Center Patient Services area for both in-patients and out-patients by consultation with medical staff. Contact the Blood Center/Pathology resident (pager 3404) to arrange for consultation, and complete the appropriate DeGowin Blood Center Consult Form in Epic. Patients must be scheduled at least 24 hours in advance unless arrangements are made with DeGowin Blood Center physicians to treat sooner in emergency circumstances. PROCEDURES CANNOT BE PERFORMED WITHOUT A COMPLETED, DEGOWIN BLOOD CENTER CONSULT IN EPIC.

1. Plasma exchange (plasmapheresis) is the removal of plasma with replacement by other fluids, usually a combination of normal saline and hetastarch or albumin.

2. Cytapheresis is the removal of cells from the patient's blood (RBCs, platelets, leukocytes) when they are suspected of causing symptoms or signs of hyperviscosity.

3. Photopheresis is the treatment of WBC with psoralen and UV light for the treatment of Sezary syndrome, GVHD, and some forms of solid organ transplant rejection.

4. LDL Apheresis is the removal of LDL-cholesterol in high risk patient populations.

5. Therapeutic phlebotomy is available for treatment of polycythemia vera, hemochromatosis, etc. This service is available Monday-Friday 0800-1700 only. If the clinical service decides to perform phlebotomy outside of these hours, refer to the Guidelines for Therapeutic Phlebotomy.

6. Peripheral blood stem cell collection is the collection of hematopoietic stem cells from a donor/patient after completion of a stem cell mobilization strategy for use in hematopoietic stem cell transplant.


AUTOLOGOUS DONOR BLOOD PROGRAM

The autologous blood program is primarily for patients who are anticipating surgery that is likely to require blood transfusions. If transfusion is not likely, the risks, expense, and inconvenience of predeposit autologous blood collection are not justified. Patients must be referred to the Blood Center by their surgeon. Additional printed information can be obtained from the Blood Center.

Patients must be in satisfactory health to easily tolerate whole blood donation. Refer only patients considered able to withstand repeated blood donations.

Hemoglobin requirement: > 11 g/dL
Hematocrit requirement: > 33%

There are no age limitations. Elderly patients are eligible. Children with adequate veins who are cooperative usually tolerate phlebotomy. Generally, it is difficult to enroll patients smaller than 35 kg (<10 yrs. of age).

Guidelines for the number of units to be collected for a particular procedure can be found in the Maximum Surgical Blood Order Schedule. Up to six units can be collected, providing the patient is referred six weeks prior to date of surgery. Therapeutic doses of ferrous sulfate can be started at the time or up to two weeks before the first donation. The dose of elemental iron is 3-6 mg/kg/day with the maximum being 200 mg elemental iron/day. The maximum dose of elemental iron corresponds to 320 mg FeSO4 tid. Iron must be prescribed by the referring surgeon; the Blood Center will not prescribe iron.

If possible, refer the patient to the Blood Center six weeks prior to surgery so that optimal scheduling of phlebotomies can occur. If scheduled later, allow one week per unit of blood requested. Generally, units of blood will not be drawn the final week before surgery. Do not refer patients with only one week until surgery.

Certain donors referred to the DeGowin Blood Center may be eligible for 2 unit red cell apheresis, depending on body size and hematocrit.

The referral and first visit must be to the DeGowin Blood Center. Subsequent donations can occur at other blood centers, and all arrangements will be made by the DeGowin Blood Center during the initial visit.

Autologous units will not be tested for infectious disease markers. Units collected at DeGowin Blood Center cannot be transferred to another hospital.

To refer a patient for this program, the referring physician’s clinic must contact the DeGowin Blood Center at 356-2058 or to schedule an appointment. Complete a "Consult DeGowin Blood Center Blood Donation, Autologous" in Epic.

Audit Criteria for Transfusion


HEMATOPOIETIC PROGENITOR CELLS

The Circular of Information for the use of Cellular Therapy Products is considered an extension of container labels as the space on those labels is limited. The Circular of Information contains sections on general information, side effects and hazards, hematopoietic progenitor cell sources and products, and manipulated products. The circular was prepared jointly by the AABB, America’s Blood Centers, American Association of Tissue Banks, American Red Cross, American Society for Apheresis, American Society for Blood and Marrow Transplantation, Foundation for the Accreditation of Cellular Therapy, International Council for Commonality in Blood Bank Automation, International Society for Cellular Therapy, and National Marrow Donor Program.

Tissue and Cellular Therapies staff members prepare hematopoietic cells for infusion. For a list of procedures performed, please go to Tissue and Cellular Therapies on the DeGowin Blood Center website.


SURGICAL TISSUE

DeGowin Tissue Bank dispenses all human autologous and allogeneic tissue implanted at UIHC, except sperm and oocytes. For a list of available tissue types, see the Epic Tissue: Master Order. To order tissue, please refer to the Surgical Services policy SS-10.006, Tissue Bank: Ordering, Receiving, and Returning Human Tissue. It is appropriate to order tissue in advance for cases where there is a significant (>25%) chance that it will be needed.

If an unusual tissue request is being made, please complete the O.R./ASC Staff Product Request Form referred to in Section "F" of the Surgical Services policy SS-10.006, Tissue Bank: Ordering, Receiving, and Returning Human Tissue. A one use trial of the tissue may be requested directly from the Tissue Bank at the time that the product request form is submitted to the OR Product Evaluation Committee.