GENERAL INFORMATION, TEST DIRECTORY & ORDERING BLOOD COMPONENTS LOCATION & HOURS OF SERVICE

Laboratory Section	Location	Hours	Telephone (734) 93
Main Laboratory	2F225 University Hospital	24/7	936-6888
Human Progenitor CEll processing (HPC) laboratory	2F225 University Hospital,	Mon-Fri Friday 8:00 AM to 4:30 PM.	936-6867
Immunohematology Reference Laboratory	2F225 University Hospital	Mon- Fri 7:30 AM to 4:30 PM. Emergency services	936-6870
TRANSFUSION AND APHERESIS SERVICES (TAS)	2F221 University Hospital	Mon- Fri Friday 7:30 am to 4:00 pm After Hours, holidays and week-ends	936-6900   Call 936-6888 to obtain the name and pager number of the Pathology House Officer On Call.
Medical Staff	2F225 University Hospital	Available or On-call 24/7	Call 936-6888 to obtain the name and pager number of the Pathology Medical Staff On Call.
Pneumatic tube station	E 2

Registrations and Accreditations

• FDA Registration Number 1870530
• College of American Pathologists
• Foundation for the Accreditation of Cellular Therapies
• Transfusion Service accredited by the American Association of Blood Banks
• Immunohematology Reference Laboratory accredited by the American Association of Blood Banks

TEST DIRECTORY

Routine Pretransfusion Testing

Test Name	Abbreviations	Tests	Comments
Type and Screen	TS ITS (infants)	ABO, Rh and Antibody screen	Required before issuing components for transfusion

• Patient must be identified by a patient identification wristband and the wristband must remain on the patient.
• A sample used for Type and Screen is available for crossmatching for three days after submission.

Regulatory agencies mandate that if the patient has been transfused or pregnant within the last three months, the blood sample used to perform pretransfusion testing must have been collected within three days of the transfusion. Samples used for crossmatching blood for patients known to have significant blood group antibodies must also be collected within three days of transfusion.

• A positive antibody screening test indicates possible sensitization to major red cell antigens outside the ABO system.

When unexpected reactions are detected in the antibody screening test, additional testing will be performed to determine the specificity of the antibody.

• A crossmatch must be performed before Red Blood Cells, Whole Blood, or Granulocytes can be transfused.
  
• Fresh Frozen Plasma, Platelets and Cryoprecipitate do not require crossmatching as they lack, or contain minimal, red cells. However, a blood sample may be required to determine the patient's ABO and Rh type.

Test Name	Abbrevia-tions	Tests	Comments
Preadmission Type and Screen	PTS PTSI (infants)	ABO, Rh and Antibody screen	Pretransfusion testing prior to surgery or outpatient transfusion

 

• A preadmission sample may be collected up to one month prior to surgery if the patient

1. does not have unexpected blood group antibodies and
2. has not been transfused or pregnant within the last three months

• Samples collected for this program must be identified using an alphanumeric identifier provided on a PTS identification form.
• Upon admission, the patient must provide the identification form with the alphanumeric identifier to assure that the identity of the patient corresponds with the sample.
• PTS forms and additional information about this program may be obtained from the Blood Bank Main Laboratory 6-6888.

 

 

Prenatal, Postpartum and Pregnancy Related Studies

Use the Prenatal Studies Section of the Blood Bank Requisition.

Test Name		Abbrev-iations			Sample			Tests
Prenatal Type and Screen		PN			6 mL Pink Top Tube			ABO, Rh and Antibody screen
These tests are performed on newly-diagnosed pregnant patients in order to identify those women whose infants may be affected by hemolytic disease of the newborn, to facilitate the provision of blood for both mother and infant at the time of delivery and to identify candidates for Rh Immune Globulin. Antibody identification studies will be performed if the antibody screen is positive.
Antibody Screen Only		AS				6 mL Pink Top		Antibody Screen
Antibody identification studies will be performed if the antibody screen is positive. While it can be performed throughout pregnancy, it is generally performed during the 28th week of gestation to monitor the development of unexpected antibodies in the serum of women previously tested for ABO and Rh and whose antibody screening test has been negative. This test is recommended for Rh-negative women and those Rh-positive women known to be at increased risk of antibody sensitization, such as previous history of antibody production, history of red cell transfusion, or placental incompetence.
Pregnant Patient Known to Have Antibodies		ABID				Two 6 mL Pink Top Tubes		Panel to determine specificity of antibodies
Antibody identification tests are performed on serum from women known to be immunized to red cell antigens (from a previous pregnancy or blood transfusions) who currently demonstrate a positive antibody screen. Antibodies with specificity known to cause hemolytic disease of the newborn (HDN) are titrated, to assist in determining the need to monitor the severity of HDN by other means (e.g. amniotic fluid analysis).
Test Name		Abbrevi-ations				Sample		Test Components
Probable Paternal Genotype		OB Father				6 mL Pink Top Tube		Dad BT
Determination of the probable genotype of the putative father of the fetus in order to assess the potential for hemolytic disease of the newborn (HDN). The requisition and blood sample should be submitted with the pregnant woman’s name and registration number. The man's name should be noted on both the tube label and the requisition. If the obstetrical antibody identification study was performed elsewhere, include the findings on the requisition.
Rh Only	RHA			Pink Top 6 mL or Glass Red Top Tube (no clot activator)			Rh type
Required to determine the Rh type of any woman admitted for delivery, abortion, or amniocentesis. It is intended to recognize those women who may require Rh Immune Globulin therapy. This test may also be used to determine the Rh type of organ donors.
Fetal-Maternal Hemorrhage Screen			FMH	6 mL Pink Top Tube			FMH
Used to detect Rh positive fetal red cells in the circulation of an Rh negative woman. The test is automatically performed by the Blood Bank before issuing Rh Immune Globulin (RHIG) postpartum on a sample collected at least one hour post delivery or on an antepartum sample from an Rh negative women thought to have sustained a significant fetomaternal hemorrhage. If this screening test is positive, a Kleihauer-Betke Fetal Hemoglobin test is required to determine the amount of RHIG to administer.

NEWBORN INFANT STUDIES

Use the "Infant Studies" section of the Blood Bank Requisition

Rh Negative Mother, Rh(D) Immune Globulin Evaluation		Cord Blood Sample in 6 mL Pink top tube
This study consists of testing the infant's blood for Rh to determine if the mother of the infant should receive Rh Immune Globulin (RHIG). A 5-10 mL sample of umbilical cord blood is required, preferably obtained by venipuncture of the cord vessel. If the blood sample is obtained from the cut end of the umbilical cord, do not squeeze the cord since tissue thromboplastin interferes with the studies. A 1 (one) mL venous sample may be used when cord blood is unavailable.
Test Name	Abbrev-iations	Sample	Tests
Jaundiced Infant Studies		Umbilical cord blood in a yellow top tube or (7/22/05) 3 mL venous blood in Pink Top tube	ABO, Rh, a direct antiglobulin (Coombs) test
These studies are intended for the evaluation of the newborn infant who has, or is suspected of having, hemolytic disease of the newborn (HDN). Additional studies will be performed if the direct antiglobulin test is positive. Blood samples accompanying an infant referred to the University of Michigan Hospitals for treatment should be submitted to the Blood Bank immediately. The mother's ABO and Rh group and result of most recent antibody screen should be noted on the requisition. If the infant was born at another hospital, include the name of the hospital. Infants with ABO hemolytic disease of the newborn may have a negative direct antiglobulin (Coombs) test; further testing will be pursued in the face of a negative direct antiglobulin test when this diagnostic possibility exists.
Cord Blood Exam (Mother is Known to have Antibodies)		Umbilical cord blood or 3 mL venous in Pink Top tube
This study is designed for the evaluation of an infant born to a woman known to have circulating antibody(ies) and includes tests for ABO, Rh, and a direct antiglobulin (Coombs) test with anti-IgG and additional tests as required. This study serves as a screening test for hemolytic disease of the newborn and facilitates provision of blood components should transfusion of the infant be necessary.

 

ANTOBODY STUDIES

Use the "Antibody Studies" section of the requisition

Samples Requested by Blood Bank		One 6 mL tube of blood in a Pink top tube and one 6-10 glass Red Top Tube Revised 7/19/05
An antibody study will be initiated by Blood Bank personnel to identify unexpected antibodies detected in a patient's serum, or to resolve an immunohematologic problem.
Test Name	Abbrev-iations	Sample	Tests
Direct Antiglobulin Test Only (DAT or Direct Coombs Test)	DAT	Submit 6mL of Pink top tube. This test is recommended to monitor patients who have already had a "Direct Antiglobulin Test - Complete Study."	Direct antiglobulin test performed with polyspecific serum.
This test is utilized to detect IgG immunoglobulin and/or complement adherence to red cells in immune hemolytic anemia. No further studies are performed.
Direct Antiglobulin Test- Complete Study (DAT or Direct Coombs Test)		Two 6 mL Pink top tubes generally will be required. Revised 7/22/05
This test is used to detect IgG and/or complement adherence to red cells, as seen in immune hemolytic anemia due to autoantibodies, drugs or delayed hemolytic transfusion reaction. If positive, additional tests will be performed including determination of the specific type(s) of proteins adhering to the red cells and routine tests for unexpected red cell antibodies in the serum and attached to the red cells. Additional studies, such as those to detect anti-drug antibodies, will be performed only following consultation with Blood Bank personnel.
Isohemag-glutinin Screen		Submit 3mL of blood in a pink top tube. 7/22/05
This study entails testing the patient's red cells for ABO and the serum for the expected IgM isohemagglutinins (anti-A and anti-B). The results obtained may assist in the diagnosis of immune deficiency diseases. This test is unreliable when done on serum from infants less than four months of age because maternal antibodies may be present, and infants under twelve months of age frequently have low levels of isohemagglutinins. The serum of group AB patients will be tested for the presence of naturally-occurring IgM cold autoantibodies
Test Name	Abbrev-iations	Sample	Tests
Donath-Landsteiner Test		Glass Red top tube must be submitted Samples must be maintained at 37 C following collection.	Consult with the Blood Bank Reference Laboratory staff before collection of blood samples.
This test is performed to determine the presence/absence of the biphasic hemolysin (Donath-Landsteiner antibody) associated with paroxysmal cold hemoglobinuria (PCH) - a rare cause of autoimmune hemolytic anemia.
Investigational Studies
On occasion, patients are seen at University of Michigan Hospitals with unusual red cell antigens or antibodies of academic interest. In such cases the cooperation of House Officers may be sought to obtain additional blood samples from the patient or blood relatives. No additional charges to the patient are assigned for these latter studies.

 

 

Physician Responsibility for Identifying Patients with special Blood Requirements

Physicians must notify the Blood Bank of special patient needs such as:

• irradiated components
• volume reduced components
• CMV seronegative components
• recent transfusion history such as

• blood group antibodies,
• recent transfusion at another hospital,
• recent exchange transfusion, or
• bone marrow transplant

 

Patients with Antibody Identification Cards

Patients may show staff members a card or letter listing red cell antibodies that may have been detected in their serum in the past, or give a history of past difficulties in obtaining compatible blood.

• Relay this information to Blood Bank personnel as soon as possible.
• Even though all serological tests will be repeated in the Blood Bank, some unexpected antibodies may be detectable intermittently, and information on prior immunohematologic studies may be invaluable.

Collection and Submission of Blood Samples

 

Forms and Tube Labeling

 

	Blood Transfusion Request Form	Sample Tube
Required Information	* patient's full name * patient's hospital registration number * signature of the person collecting the blood sample * date of collection * name/number of the responsible physician requesting the component	* patient's full name * patient's hospital registration number * initials or signature of the person collecting the blood sample
Additional Information	* current hospital location of the patient * specific clinical indication for the transfusion * where the component will be used - OR, dialysis, patient unit * date and time the components are needed	* birth date

• The label should be placed going up and down the tube not flagged around the middle.
• The Phlebotomy Team will collect routine Blood Bank samples and additional samples required for resolution of serological problems on scheduled collection rounds.
• Samples for urgent requests for blood components and investigation of a possible hemolytic transfusion reaction should be collected by the unit personnel.

 

Positive Patient/Blood Sample Identification

• It is impossible to overemphasize the importance of proper patient identification because inadequate or incorrect identification of patients is a common cause of serious complications associated with blood transfusion. Because name and birth date are not unique identification pair, blood samples for pretransfusion testing and blood components are labeled with the patients full name and University of Michigan CPI number.
• When a sample is collected for pretransfusion testing, all patients including outpatients and those patients receiving off-site care, must have a positive patient identifier (PPI) such as an identification wrist band or biocompatible tape containing the patient’s name and medical record number. This PPI must be attached before the sample is collected. The patient should be instructed not to remove the PPI until after the transfusion is completed.
• Blood samples will not be accepted in the Blood Bank if there is any doubt about the accuracy of patient identification.
• Unlabeled or misidentified samples will be discarded and a freshly drawn and appropriately labeled sample must be collected.
• Positive Patient Identification is required

* Ask the patient to state and spell his or her name each time a blood sample is collected.

* Confirm the patient's full name and registration number using the PPI.

* Label the blood sample tubes with the patient's full name and registration number before leaving the patient. The labels may be hand written, computer generated or printed by addressograph plates.

* The blood sample labels must correspond with the identifying information on the patient's PPI and on the Blood Bank Requisition.

* Initial and date the labels of all blood sample tubes and sign the requisition form. The initials on the sample tube and the "collected by" signature on the requisition identify the person responsible for the accuracy of the patient blood sample identification.

* Send completed requisition and appropriately labels specimen tubes to the Blood Bank together. If both tube and requisition are not received at the same time, the specimen must be recollected and sent with an appropriately completed requisition. 8/15/07

 

Identification of Unknown Patients

• If the patient's identity is unknown initially, a CPI number is assigned to the patient.
• The designation "Unknown #" with a number assigned such as "One Hundred Twenty Five" will be used as the name identifying the patient. This identification is used to label blood samples and requisitions.
• The PPI with the "Unknown" designation shall not be removed until the patient is admitted to a patient care unit.
• Blood crossmatched and labeled for the Unknown patient may be transfused to the patient even after the patient's true identity has been discovered, as long as the "Unknown" PPI remains on the patient.
• If the "Unknown" PPI is removed, a new blood sample with the patient's correct name and registration number, that matches the patient's current wristband, is required to provide blood components for transfusion.
• Name Change: When a patient’s name is changed as a protective measure, the initial PPI should not be removed until a new blood sample with the patient’s changed name and medical record number has been processed by the Blood Bank.

 

Volume To Be Collected

Adults: A full 6 mL blood sample in a pink top blood bank (EDTA) tube is required to perform a Type and Screen, and as to crossmatch multiple units of blood for most patients.

Children: A minimum of 2.0 mL of blood in a 6 mL pink top tube is required.

• Inadequate samples will require that additional blood be collected from the patient.
• A larger blood sample may be required when antibody identification studies are indicated.
• A physician on the patient's service will be notified if an antibody problem is encountered and if additional samples are required.
• Clotted blood samples (and blood samples collected in serum separator ("Corvac" or "SST") tubes are unacceptable.
• Blood samples must not be obtained from the tubing of an intravenous infusion set or drawn from a vein in which an intravenous solution is flowing. Drugs and intravenous solutions can alter serologic reactions (e.g. dextran may cause rouleaux and false positive reactions and dilute samples so that incompatibilities cannot be detected). If blood samples are collected from an anticoagulated catheter, a 1mL sample should be collected and discarded before the collection of the blood sample.

 

TRANSPORT OF BLOOD SAMPLES

Samples should be transported directly to the Blood Bank.

They may be

• hand carried or
• sent using the pneumatic tube system (tube station E-2).

Do not send sample to Central Distribution as this will delay receipt.

 

SAMPLE PROCESSING AND TURN-AROUND TIME

• If no difficulty is encountered in compatibility testing, routine orders for Red Blood Cells will be available within two hours after receipt of the order.
• An identified urgent need for blood or blood components will take priority over other blood orders. Notify the Blood Bank of the urgency of the request so that a priority can be assigned to the request.
• Platelets, Fresh Frozen Plasma, Cryoprecipitate, and other components with storage limits of less than twenty-four (24) hours after preparation should be requested no more than one hour prior to the intended transfusion time.
• The Blood Bank will call the patient unit when components are ready for transfusion.

Reserved Units

• Crossmatched units of red blood cells and other blood components will be held in the Blood Bank for a maximum of three days from the time the crossmatch sample was collected.
• The component reservations will be canceled at midnight. For example, if the Type & Screen sample was collected on the 4th day of the month at noon, any reservations for crossmatched units of blood would be canceled at 23:59 (11:59 pm) on the 7th.
• Unless approved by the Pathology House Officer, a maximum of two units of crossmatched red blood cells will be held for a patient. In most cases, additional units are available quickly and reservation of additional units is unnecessary.
• Staff members should notify Blood Bank personnel if the components reserved will no longer be needed so that they can be used for other patients.

 

Use of Non-Type Specific Components

Refer to the compatibility chart (on back cover of printed booklet).

ABO: In some circumstances it may be necessary to provide blood components that are not of the same ABO or Rh type as the patient. A common example of such a situation is the group AB patient who is given group A Red Blood Cells.

Rh: Rh positive blood may be supplied to an Rh negative patient with an immediate need for massive transfusion when sufficient Rh negative units are not available or when crossmatched or HLA matched single donor platelets are required. In such a setting, the risk of sensitization is outweighed by the need for blood. The Medical Director of the Blood Bank will review transfusions of Rh Positive components to Rh Negative patients  and will notify the patient's physician should Rh Immune Globulin be indicated.

Ordering Components

Orders may be submitted

• on a paper requisition sent via pneumatic tube or hand carried to the Blood Bank,
• faxed to the Blood Bank (6-6854),
• or ordered on an electronic order "e-mail form".

Written orders are required for routine orders. Emergency requests or add on requests from the operating room initiated by telephone must be followed up with a documented order.

To place an order to prepare components, provide the Blood Bank staff with the following information on a paper or electronic form:

• name and hospital registration number of the patient
• component and quantity required
• special requirements
• name or number of the ordering physician
• anticipated time of transfusion
• location of the patient

If blood is needed urgently, call the blood bank and indicate the nature of the emergency. Request emergency release of blood components if blood products are needed before compatibility testing can be completed.

SPECIAL CONSIDERATION FOR TRANSFUSION OF INFANTS LESS THAN 4 MONTHS OLD

• Samples for pretransfusion testing should be collected in syringes and transferred into 6 mL pink top tube half filling the container. A minimum of 2.0 mL of blood is required.
• After the initial determination of ABO, Rh type and screening for unexpected blood group antibodies, it is not necessary to repeat these tests before the transfusion of most infants less than 4 months old. Consult with Blood Bank personnel before collecting additional samples from infants less than 4 months old.
• Due to the special needs of newborns, the Blood Bank provides partial units of Red Blood Cells and plasma in bags and syringes as well as single units of platelets prepared in syringes.
• When ordering components for these patients, indicate the volume to be transfused.

Revised 10/24/2008