This test is to be used to place orders for blood products when 
special requirements need to be met.  The order includes several 
questions for the provider to answer which will help the blood bank 
determine what testing is required, how many products are needed and 
when they need to be available.  This test should be used when ordering the following:

  •Red Blood Cell (RBC) units for a patient with Red Blood Cell
   Antibodies and future transfusion needs.
  •RBC units for patients with special red cell antigen needs.
  •Platelets for patients who are refractory to transfusion.
  •Blood products for patients with severe allergies to blood
   transfusion (i.e. IgA deficient).

For patients with RBC antibodies, specify whether the request is for a 
liver transplant, ABO incompatible heart transplant, MAP patient, a RBC exchange or routine anticipated RBC requirements.  Indicate the number of units requested and when the units are needed.  Select Not applicable for all other product requests.  Note:  RBC units are not routinely crossmatched for patients with antibodies unless they are ordered through a Pre-Transfusion Special Testing Order.

For patients with special red cell antigen needs, select Anticipated 
RBC Requirements, specify the number of units requested and when they 
will be needed.  Select Not applicable for all other product requests.

For patients with platelet antibodies, select Crossmatched/HLA 
Matched.  Indicate the number of units requested and when they will be 
needed. Select Not applicable for all other product requests.

   Platelet Crossmatch is used for patients refractory to platelet
   transfusion to determine whether a platelet is more likely to
   provide a good platelet increment in that patient. This is
   generally performed after the platelet antibody screen has been
   positive. In some cases, identification of HLA specific antibodies
   may assist in the identification of platelets for transfusions.
   This testing is ordered separately and performed by an outside
   reference laboratory.  HLA matched platelets take 3-5 days and are
   generally ordered after the platelet antibody screen and crossmatch
   have failed to identify compatible platelets. HLA platelets can
   only be provided if the patient's HLA type is known.

   Many patients are refractory to platelet transfusion for non-immune
   causes such as DIC, bleeding, splenomegaly, regardless of the
   results of this test. No one test is capable of detecting all
   antibodies to platelets. Our experience indicates that crossmatch
   compatible platelets only give good responses in about 1/3 of
   patients.

Please Note:  Platelet Crossmatching and HLA matched platelets must be 
approved by the Clinical Pathology Resident at pager #3404.  Contact 
the Pathology Resident to determine if Crossmatched or HLA Matched 
platelets are appropriate.

In rare circumstances, patients may require washed blood. Examples 
include infusions of large volumes of blood rapidly into small 
children/neonates.  Select Washed under Special Requirements and 
indicate when the products are needed.  Select Not applicable for all 
other product requests.

For patients with severe allergies to blood transfusion, indicate 
Washed (for RBC and platelet products) or IgA Deficient (for plasma 
only products) and indicate when the products are needed.  Select Not 
applicable for all other product requests.  Note:  Obtaining IgA 
Deficient plasma may take several days as it requires documentation of 
IgA deficiency and possibly IgA antibodies.  Contact the Clinical 
Pathology Resident at pager #3404 to discuss the process for qualifying the patient for IgA Deficient plasma and obtaining the product.