Blood Bank Transfusion Services
To contact the Blood Bank or Transfusion Service call (585) 922-4083. The Transfusion Service is located on the ground floor near the red elevators.
The Rochester General Hospital Transfusion Service is staffed seven days a week, 24 hours a day. The Transfusion Service performs testing for transfusion of approximately 13,500 components a year. The components transfused include red blood cells, fresh frozen plasma, platelets and cryoprecipitate. We also supply Rhogam omit micrhogam for obstretical patients. The Transfusion Service has an extensive reference lab. We perform antibody identification, autoadsorptions, antibody titers on pregnant women and other specialized tests. The Transfusion Service is responsible for the storage and compatibility testing of blood and blood components and for special immunohematology studies.
Specimen labeling criteria is stringent to ensure proper patient identification for transfusion. On September, 2002 we initiated the use of blood recipient identification bands as a second identification for the drawing of blood bank specimens and for patient identification at the time of transfusion. When specimens are drawn for the Transfusion Service a blood recipient identification band is placed on the patient. The specimens are labeled with the patient’s full name, date of birth, medical record number, date/time drawn, employee identification numbers of the two personnel who drew the specimen, and the unique number from the blood recipient identification band. This unique number stays with the patient for the current admission and is used along with the patient’s name, date of birth and medical record number as another identifier when specimens are drawn and units are transfused.
Specimen requirement for the Transfusion Service is a properly labeled 10 cc EDTA tube. Testing is performed using the MTS Gel technology. This testing method is more sensitive compared to the traditional tube method. Antibodies are detected earlier which may lead to increase red cell survival in transfused units.
Patients who undergo elective surgery can be a candidate for donating their own blood at RGH. If a need for transfusion arises, this would reduce the need to use blood from another person. The patient’s physician would initiate this request.
Dr Dawn K. Riedy: (585) 922-9870
Dr William Fricke: (585) 922-4576
Glenda Spencer MT (ASCP) SBB Transfusion Service Manager: (585) 922-4085
Margaret Axon MT (ASCP) Lead Technologist: (585) 922-4084
Michael Battaglia MT (ASCP) Senior technologist (Day shift): (585) 922-4084
Janet Maitland MT (ASCP) Senior Technologist (Eve shift): (585) 922-4084
Ordering Blood For Surgery
A pre-op blood specimen for crossmatching must be in the Transfusion Service no later than 3 PM the day before surgery. Failure to observe this rule may make it necessary to cancel cases if we have difficulty finding rare types or identifying atypical antibodies. It is the responsibility of the physician to be sure the orders reach the Transfusion Service and blood is available. Orders may be written with preadmission orders, or after admission.
When a "Type and Screen" is ordered, the patient's blood is typed and plasma screened for atypical antibodies. Blood of the correct type will be available in the Transfusion Service, but not crossmatched. Type and screen is recommended in lieu of type and crossmatch when the likelihood of needing blood is low. If blood is needed during surgery or post-operatively, a crossmatch will be started and blood may be released after a 5 minute crossmatch that rechecks the ABO compatibility of the donor and recipient. Copies of surgical procedures or suggested maximum blood orders for elective surgeries are available in Transfusion Services. The maximum blood order schedule will be adhered to by the Transfusion Service staff, unless notified by a physician regarding a particular case.
When ordering testing for the Transfusion Service complete the questions concerning transfusion /pregenancy history and if the patient has an antibody card. Always indicate previous reactions and any previous difficulties in crossmatching, if known. Call the Transfusion Service if you know of a problem that may cause difficulties.
Elective surgeries requiring 4-5 or more units of blood and those patients with known incompatibilities should have orders sent to the Transfusion Service a few days prior to date of surgery.
Routine Blood Orders
All routine orders for Red Blood Cells (transfusions given for chronic anemia) should be received in the Transfusión Service by 9:00 am the day of transfusion. Stat work, as always, is honored with priority anytime.
Please refer to the "RGH Clinical Laboratory Manual" for a complete detailed listing of the specimens needed, the proper requisitions that may be necessary, and the correct policy regarding each type of component.
Indications for transfusion must be properly documented in the patient's chart by the ordering physician. This information must be noted on the Transfusion Service Component Request form before the component is issued by the Transfusion Service.
New Crossmatch Specimens
A new crossmatch specimen must be drawn every 3 days if a patient has been transfused or pregnant in the past 3 months. A fresh recrossmatch tube received early in the day will usually be sufficient for all the patient's needs that day and the following two days. Transfusion may stimulate antibodies which were not demonstrable in the old specimen. If a patient has not been transfused or pregnant in the past 3 months, the tube may be used for crossmatch for 15 days (day 1 being the day the specimen was drawn).
Outpatients are transfused in the Cancer Center (585) 922-5015. Please call the department directly to schedule the transfusion. The Cancer Center will provide a list of possible transfusions for the next day to the Transfusion Service so that pre-transfusion testing may be done. Because many outpatients are transfused repeatedly, they frequently have compatibility problems that require lengthy work-ups. For this reason it is preferable that these patients have their pre-transfusion specimens drawn 24 to 48 hours prior to transfusion; however, no more than 72 hours prior to transfusion.
For patient safety, specimens must be labeled from a wristband that will remain on the patient until after the transfusion is completed (for outpatients) or until patient is discharged (for inpatients).
Procedure for Using the Blood Bank Wrist Band
(Refer to the “Blood Recipient Identification Band” procedure on CCS
Emergency Release of Blood/Time Necessary for Procedures
Specimens must be clearly labeled with the full patient name, medical record number, date of birth, and two phlebotomist employee ID numbers. In crisis situations, when patient name is not known, a specimen with only a hospital number and two phlebotomist ID numbers on the tube will be accepted.
|Uncrossed O negative packed red cells < 5="">
||Crisis release form (must be signed by ordering physician) is necessary, as well as a pretransfusion patient specimen for subsequent blood typing and cross matching.
|Uncrossed group specific blood 5-10 min.
||Crisis release form is necessary.
|Type and Screen with 5 min. crossmatch 45 min.
Crisis release form is not needed. Patient is typed and screened for atypical antibodies. If negative for atypical antibodies, blood can be issued following a 5 minute crossmatch that confirms the donor and recipient ABO compatibility.
NOTE: Once a Type and Screen has been completed, blood can be released after performing a 5 minute crossmatch.
|Antiglobulin Crossmatch 40-45 min.
||Includes type, screen for atypical antibodies, and complete antihuman globulin phase crossmatch. The antiglobulin crossmatch is performed only when a patient's plasma is demonstrating atypical antibodies. In other cases, the abbreviated 5 minute crossmatch is performed (see above).
Blood on Reserve
Blood crossmatched for a patient is released automatically in approximately 72 hours, unless a specific request is made to hold. Blood is released at 7-8 am daily. This may mean that blood set up after 12 pm will be released in less than 72 hours. The Transfusion Service will honor "keep units ahead" orders on unstable, bleeding patients. The patient should be re-evaluated following each transfusion for future transfusion needs.
Requests for washed red cells, frozen red cells must be cleared through the Transfusion Service Director or the hematologist/oncologist. These components are specially ordered from the American Red Cross during the day. Pheresis products such as single donor platelets and granulocyte concentrates must be ordered after Hematology Consult. These products have a short shelf-life and should be transfused promptly.
Please send all transfusion reaction work-up requests immediately to the Transfusion Service.
- Stop blood
- Draw a properly labeled 10 cc. lavender top tube from the recipient
- Send specimen, blood container and any associated IV tubing and IV solutions administered with the transfusion with Transfusion Investigation Form (completed with the signature of the tranfusionist and the doctor notified), and the product identification tag to the Transfusion Service immediately. Order a transfusión reaction test in CCS
- Collect first voided urine and send to Urinalysis Lab with urine requisition marked "SUSPECTED TRANSFUSION REACTION."
All reactions will be investigated with appropriate testing in the Transfusion Service. The results will be interpreted and recommendations made by the Transfusion Service Director.
Autologous (Autogeneic) Donations at RGH
Autologous blood (patient’s own blood) is the safest blood a patient can receive. For this reason, predeposit of autologous blood is encouraged in situations where appropriate. The following must be considered:
- The patient's hematocrit must be above 33%
- Date of transfusion should be predetermined (for example, elective surgery date)
- There should be a reasonable likelihood that the patient will require a red cell transfusion
- The patient may donate up to 3 days prior to surgery
- Forms to initiate this process can be obtained from the DOSA Unit (585) 922-3363. The form must be completed and signed by the physician. The form is sent to the RGH Blood Bank (1425 Portland Avenue, Rochester, NY 14621) or faxed to (585) 922-5504. Appointments can be scheduled by calling the Surgical Scheduling Office at (585) 922-5780 between 8:00 am - 4:30 pm.
Directed donation (a patient specifying his/her blood donors) is allowed under certain circumstances, however, the RGH Transfusion Service does not actively encourage use of directed donation. The reasons are as follows:
- Directed units are subject to the required and necessary tests performed on all donor units. Thus, four working days are required prior to releasing the units to the hospital. The units are therefore not readily available and can only be used when transfusion can be delayed.
- There are no guarantees that the chosen donors will be at lower risk of transmitting infectious disease than volunteer donors from the routine blood supply.
- If the units are not used by the original intended recipient, they cannot be used for any other patient. They are therefore wasted.
- If after discussing these concerns with the patient, the Transfusion Service Director and patient's physician, directed donation is felt to be appropriate, the following must be completed:
Note: If the donor and recipient are blood relatives, the unit must be irradiated to prevent graft vs. host disease. In such a case, there is a charge at the Red Cross for the irradiation, in addition to an administration fee.
- Request form is obtained from the Transfusion Service. It must be signed by the requesting physician.
- The recipient must have a type and screen done.
- The donors must be group specific and Rh compatible. They can be typed at RGH with a physician's order if necessary.
- The form, donor list and fees are taken to the Red Cross at the first scheduled appointment.
The Transfusion Service staff will make every effort to cooperate with the housestaff and will be glad to have you visit. The Transfusion Service is located on the ground floor near the red elevators.
William Fricke, MD, Medical Director: (585) 922-4576
Glenda Spencer, MT (ASCP), SBB, Manager Transfusion Service: (585) 922-4085