| Function | Location | Phone | Scheduled Hours |
| Blood Bank | C271 GH | 356-2561 | 24 hours |
| DeGowinBlood Donor Center: Blood Donation | C250 GH | 356-2058 | Call for current hours of operation |
| DeGowin Blood Donor Center: Patient Services | C250 GH | 356-2058 | 0800-1630 weekdays |
| Consultation | Pathology Resident | Pager 3404 | 24 hours |
|
Tissue and Cellular Therapies: Cellular Therapy Lab |
C271 GH | 354-5292 | 0800-1630 weekdays |
| Tissue and Cellular Therapies: Tissue Bank | C271 GH | 356-3709 | 24 hours |
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 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.
Available Blood Components
The DeGowin Blood Center maintains an inventory of Red Blood Cells, Plasma, 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 aliquoted, irradiated or washed if requested and clinically indicated.
To view DeGowin policies and procedures please refer to the Department of Pathology site on Policy Tech.
Transportation
Blood components are sent to patient care areas via the pneumatic tube system and are available for approved users from the Haemonetics blood kiosk HB80 in MOR, the HB20 in LDR, the Emergency Use blood refrigerators in MOR and in the Emergency Department.
Storage Temperature
Platelets, Cryoprecipitate and Granulocytes must be kept at room temperature – NEVER REFRIGERATED or COOLED.
If the transfusion cannot be initiated upon arrival to the patient care area, proceed as follows:
| If: | Then: |
|---|---|
|
An approved blood refrigerator or cooler is available |
Red blood cells and plasma may be stored in the blood refrigerator/cooler until ready to transfuse Do not refrigerate platelets or cryoprecipitate [See BA.P.6, Blood Product Refrigerator Outside the Blood Bank (Excludes Operating Room and/or ED)]. (available on UI Health Care PolicyTech under Affiliate » Blood Administration) |
No cooler or blood refrigerator is available |
If blood product can be transfused within 4 hours from when it was issued, then blood product may be kept on the clinical area and hung as soon as possible. If blood is unlikely to be transfused within 4 hours, then return to blood bank as quickly as possible. |
The provider decides not to transfuse |
Return the blood product to the Blood Bank. |
PRETRANSFUSION COMPATIBILITY TESTING
Type and Screen
Type and Screen is ordered for all patients who need a transfusion. 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. Significant delays in identifying compatible RBCs are possible when the antibody screen is positive. The sample is stored in the Blood Bank and is valid until midnight the third day after collection. (e.g., a sample collected on Friday at 6 a.m. is good until midnight on Monday.)
A presurgical Type and Screen is available for outpatients who are scheduled for elective surgery. This test is valid for 30 days if the antibody screen does not detect clinically significant antibodies. Patients who have a history of clinically significant alloantibodies or who have been pregnant or transfused in the previous 3 months are not eligible for this test.
Additional (reflex) testing necessary to provide blood components, WILL BE performed unless indicated in Epic or a signature is present on the Blood Center Request form A-1a to prohibit it.
Crossmatch
When blood is ordered (See Transfusion Order Requirements on the Epic order) and 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 to the blood bank. The Red Blood Cell unit is generally available within 15 minutes. Returned units are not held for a given patient.
When a patient has a clinically significant antibody, history of a clinically significant antibody or a current clinically insignificant antibody, an antiglobulin crossmatch is performed and the donor’s cells are tested for the corresponding antigen if possible. 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). In emergency situations, antigens negative units may be provided if available.
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 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 provider 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.
PRE-TRANSFUSION SPECIAL TESTING ORDERA 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 platelet transfusions, or have had significant allergic reactions to blood product transfusions.
Placing this order in advance allows the Blood Bank to make arrangements to procure hard to find or unusual blood components and to avoid transfusion delays.
It is the University of Iowa Hospitals & Clinics policy CC.P.2 Documentation of Informed Consent (available on UI Health Care PolicyTech under Affiliate » Clinical Care) to obtain informed consent before transfusing blood components in nonemergency settings. The AABB and The Joint Commission both require the need for informed consent prior to blood transfusions. The Transfusion Workgroup has approved the following methods of obtaining informed consent before non-emergent blood transfusions. These forms are available electronically on The Point/ Clinical Web Links/Medical Records Form/Other Specific Consent Forms.
The forms are as follows:
Form G-2d2 - "Consent for Blood Transfusion" includes information about blood transfusion risks, benefits, and alternatives; patient signature to consent or decline a blood transfusion and witnessed by provider.
Form G-2d2 - "Consent for Operation or Procedure" includes information about blood transfusion risks, benefits, and alternatives; patient signature to consent or decline a blood transfusion and witnessed by provider.
Form G-2e - "Patient Treatment Agreement 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.
As outlined in CC.P.2 Documentation of Informed Consent, 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.
Completed blood transfusion consents are scanned into Epic and are viewable in the Chart Review Media tab.
BLOOD CENTER SPECIMEN COLLECTION
Refer to the following policies:
BA.P.8 Blood Specimen Collection for Type and Screen and all Blood Bank Samples (available on UI Health Care PolicyTech under Affiliate » Blood Administration)
DeGowin Blood Center BC-401.5: Specimen Acceptance Criteria (available on Pathology PolicyTech under DeGowin Blood Center » "400 - Blood Bank Serologic Testing and Transfusion Management")
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 & Clinics policy cannot be accepted. Specimens that are unlabeled, illegible, or incomplete cannot be accepted. Unacceptable samples will be discarded and will need to be recollected.
For patients of unknown/undetermined ABO/Rh group, group O Red Blood Cells (RBCs) are available in the following locations for emergency transfusion:| Location and Number of Units | Action Required by Ordering Physician |
|---|---|
|
Emergency Department (ED)
|
|
|
Emergency Blood Refrigerator
|
|
|
HB20 Labor and Delivery (LDR)
|
|
|
Main Blood Bank (BBM)
|
|
Blood Bank must have a current blood specimen to issue RBC units that are ABO-type compatible. Reliance on previous records to obtain a blood type is not permissible for RBC transfusions. Reliance on previous records to obtain a blood type is not permissible for RBC transfusions.
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).
Before sending for blood, the transfusionist should ensure that venous access has been established as described in the following policies (available on UI Health Care PolicyTech under Affiliate » Blood Administration):
BA.P.1 Blood and Blood Component Administration with Appendices
BA.P.3 Blood Product Administration in Adult Patients
BA.P.4 Blood Product Administration in Pediatric Patients
| 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:
BA.P.1 Blood and Blood Component Administration with Appendices (available on UI Health Care PolicyTech under Affiliate » Blood Administration)
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 (available on Pathology PolicyTech under DeGowin Blood Center » 400 - Blood Bank Serologic Testing and Transfusion Management)
Start the transfusion slowly
If patient condition permits, start the transfusion slowly at one ml per minute for the first 15 minutes. As with all RBC transfusions, infusion must be completed within 4 hours.
Observe the patient continuously during this time 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 BA.P.1 Blood and Blood Component Administration, Appendix D (available on UI Health Care PolicyTech under Affiliate » Blood Administration).
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.
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 instructions for handling transfusion reactions in policy BA.P.1 Blood and Blood Component Administration – Appendix D 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, hives, itching or fall in blood pressure.
STOP the transfusion immediately, maintaining the IV with 0.9% saline.
Minor allergic reactions can be treated, evaluated by the provider to determine if it is an allergic reaction. Per the provider’s decision, the transfusion may be restarted without ordering a transfusion reaction workup.
When the transfusion is restarted, observation and vital signs should be obtained as if initiating a new transfusion (e.g., prior to restarting, at 15 minutes and within one hour of completion).
Refer to the Blood Administration policy BA.P.1: Blood and Blood Component Administration Appendix D. (available on UI Health Care PolicyTech under Affiliate » Blood Administration)
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.
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.
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 contains sections on general information, donors, side effects and hazards, cellular therapy product sources and descriptions, storage, dosage and administration, and labeling. The Circular was prepared jointly by multiple blood and cell therapy organizations and is recognized as acceptable by the Food and Drug Administration.
Tissue and Cellular Therapies staff members process hematopoietic cell and mononuclear cell products and prepare them for infusion. For a list of procedures performed, please go to the DeGowin Blood Center website.
DeGowin Tissue Bank dispenses all human autologous and allogeneic tissue implanted at UI Hospitals & Clinics (UIHC), except organs, sperm, and oocytes.
For tissue availability, please contact DeGowin Tissue Bank at 356-3709.
To order tissue, please refer to the Perioperative Services policy PS.P.05.06.04 Tissue Bank: Ordering, Receiving, Use, Handling and Returning Human Tissue (available on UI Health Care PolicyTech under Department » Perioperative Services » Surgical Services Manual » Medications, Tissue, and Blood Product Administration). It is recommended 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 the Perioperative Services PS.P.05.06.04 Tissue Bank: Ordering, Receiving, Use, Handling 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 Product Evaluation Committee.