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APPENDIX 210.

BLOOD BANK NAME AND ADDRESS

PATIENT BLOOD BANK RECORD


Name

D.O.B.

HISTORY: ABO

Rh

Patient #

Sex

Primary Physician/Service

Antibodies (see antibody workup file)

Diagnoses
Comments:
ABO Grouping
Date

Anti- AntiA
A
B
cells

ABO
B
inter
cells
p

Rh Typing
AntiRh

Wk D
(AHG)

CC

Antibody screen
Rh
contr
ol

IS

37O

AHG

CC

Interp

Comment

Initial
s

ASI
ASII
ASIII
ASI
ASII
ASIII
ASI
ASII
ASIII
ASI
ASII
ASIII
ASI
ASII
ASIII
ASI
ASII
ASIII
*Rh control (6% albumin, 1 drop pt. serum/plasma, other) is only used for group AB individuals (see Rh typing SOP)
Acceptable interpretations: Pos = positive, Neg = negative
Reaction grading:4+ = one solid agglutinate, clear background, 3+ = several large agglutinates, clear background, 2+ = medium agglutinates, clear to sl. turbid background, 1+
= small agglutinates, turbid background, w+ = tiny agglutinates, turbid background (weakest rxn observable macroscopically), ww+ = microscopic agglutinates, 0
= no agglutination, H = hemolysis, mf = mixed field

CROSSMATCHES
Unit status (Date/time)
Date

Unit
number

IS

37

AH
G

CC

Inter
p

Tec
h

Issued

Returned
to BB

Returned
to
inventory

Acceptable interpretations: Comp = compatible, Inc = incompatible


Reaction grading:
4+ = one solid agglutinate, clear background, 3+ = several large agglutinates,
agglutinates, clear to sl. turbid background, 1+ = small agglutinates, turbid background, w+ = tiny agglutinates,
turbid background (weakest rxn observable macroscopically), ww+ = microscopic agglutinates, 0 = no agglutination,
H = hemolysis, mf = mixed field