Blood Center Services

Adverse Reactions to Transfusion
Bacteria Detection Tests
Blood Administration
Blood and Blood Components
Circular of Information - Blood
Circular of Information - Cellular Therapy
Emergency Issue of Blood
Guidelines for Therapeutic Phlebotomy
Hematopoietic Progenitor Cells
Hold Guidelines for Pretransfusion Compatibility Testing
Informed Consent
Location and Service Hours
Massive Transfusion Protocol
Maximum Surgical Blood Order Schedule
Patient Services
Pretransfusion Compatibility Testing
Pretransfusion Special Testing Order
Surgical Tissue
Transfusing Incompatible Red Blood Cells
Transfusion Order Requirements

LOCATION AND SERVICE HOURS

Function Location Phone Scheduled Hours
Blood Bank C271 GH 6-2561 24 hours
DeGowinBlood Donor Center: Blood Donation C250 GH 6-2058 Call for current hours of operation
DeGowin Blood Donor Center: Patient Services C250 GH 6-2058 0800-1630 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 and will require 24-48 hours to obtain. All Red Blood Cells and Platelets are leukocyte-reduced, and are considered equivalent to CMV-seronegative. Cellular components can be irradiated or washed if requested and clinically indicated or as indicated by established protocol.

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

Transportation

Blood components (except for Granulocytes) can be transported to patient care areas via the pneumatic tube system. This method of transport is used when immediate transfusion is planned, or when there is an approved blood refrigerator in 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:


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 until midnight the third day 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 blood product dispense/administer order in Epic. See Transfusion Order Requirements.

If the patient's current and previous antibody screens are negative, an electronic crossmatch is performed to detect ABO incompatibility only. When the nurse is ready to transfuse, they must release the dispense order. 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
To avoid multiple venipunctures, the patient care area may collect a pre-transfusion compatibility specimen before it is determined that pre-transfusion compatibility testing is necessary. The specimen is sent to the Blood Bank to hold until testing is desired. The order name is Blood Bank Sample Hold.


TRANSFUSION ORDER REQUIREMENTS
A transfusion treatment is defined as the infusion of blood component(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. A licensed independent practitioner (LIP) must place a dispense/administer order in the medical record for each transfusion event.

Each order must include the name of the component, special instructions (e.g., irradiated, washed), 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 component. Each transfusion treatment requires a separate order.

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.


PRE-TRANSFUSION SPECIAL TESTING ORDER
A special order can be made in advance for patients who have planned transfusions and known red cell antibodies, special RBC 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 Joint Commission, note the need for informed consent prior to blood transfusions in their accreditation manuals. Members of the Transfusion Subcommittee have approved three 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.

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 SPECIMEN COLLECTION

Refer to the following policies

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

DeGowin Blood Center policy BC-401.5: Specimen Acceptance Criteria

Provision of Care/Patient Care policy PC-BA-01.000: Blood and Blood Component Administration (refer to Appendix D, F, RN Adult and RN Pediatric documents)

Patient identification on the specimen label must be legible. Specimens must have a complete, eye readable patient name and hospital number. Specimens that are not collected as specified in the above University of Iowa Hospitals and Clinics policies cannot be accepted. Specimens that are unlabeled, illegible or incomplete cannot be accepted. Unacceptable samples must be discarded and will need to be recollected.


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/SNICU Blood Admin (0-/0+ Floor Stock) Order
Surgical Neuroscience Intensive Care Unit (SNICU)
  • 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/SNICU Blood Admin (0-/0+ Floor Stock) Order
Main Blood Bank (BBM)
  • Inventory of RBCs, O Rh negative and O Rh positive
  • Complete an Epic blood product dispense/administer 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 (downtime)

Blood Bank must have a current (within 3 days) blood specimen to issue RBC units that are ABO-type compatible. Reliance on previous records to obtain a blood type is not permissible.

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 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 and Rh type-compatible, antigen negative RBCs are issued for patients whose ABO/Rh type has been determined and are known to have a clinically significant RBC antibody by history or current testing (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 policy

Provision of Care/Patient Care policy PC-BA-01.000: Blood and Blood Component Administration (refer to Appendix D, F, RN Adult and RN Pediatric documents)

Acceptable for use with transfusion     Comment
0.9% saline Only solution approved for direct mixing with blood

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. Note: Do not mix containers of blood components together prior to transfusion.

Use of blood filters:

Refer to the Provision of Care/Patient Care policy PC-BA-01.000: Blood and Blood Component Administration (refer to RN Adult and RN Pediatric).


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. Blood Center physicians 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 there is evidence of a transfusion reaction

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


ADVERSE REACTIONS TO TRANSFUSION


BACTERIA DETECTION TESTS

Apheresis platelets are cultured for evidence of bacterial contamination. Cultures may take several days for results and products may be transfused prior to the positive result. 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 inpatients and outpatients by consultation with medical staff. Contact the Blood Center/Pathology resident (pager 3404) to arrange for consultation, and complete the appropriate Consult DeGowin Blood Center Form in Epic. Patients must be scheduled at least one working day 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 albumin with or without normal saline.

2. Cytapheresis is the removal of cells from the patient's blood (RBCs, platelets, leukocytes) when counts are very elevated and 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. Therapeutic phlebotomy is available for treatment of polycythemia vera, hemochromatosis, etc. This service is available Monday-Friday 0800-1630 only. If the clinical service decides to perform phlebotomy outside of these hours, refer to the Guidelines for Therapeutic Phlebotomy.

5. 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.


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. Tissue and Cellular Therapies staff members process hematopoietic cell products and prepare them 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 UI Hospitals and Clinics, except sperm and oocytes. For a list of available tissue types, see the Epic Tissue: list. 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 three working days in advance of the procedure for cases where there is a significant (>25%) chance that it will be needed.

If a tissue request for a product new to UIHC 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.