BLOOD BANK

 TECHNICAL MANUAL

SPECIMEN COLLECTION

Blood Bank Specimen Collection Guidelines

Proper patient and specimen identification are of critical importance for safe transfusion.
Clerical error is the most common cause of disaster in blood transfusion. A freshly drawn specimen
will be required before transfusion of type-specific products when there is any question concerning
proper identification of a specimen or patient. Mislabeled, incompletely labeled and unlabeled
specimens will not be processed for transfusion. No exceptions to these rules are allowed.

Outpatient Specimen Guidelines

Non-Transfusion Specimens, Including Prenatal, Blood Types and Antibody Screens

Ask the patient to state the following patient identification information and present
picture identification, if available:

 Full name (first and last)

 Date of birth (DOB)
 Social Security Number, if available

Required Sample
Adults: Two full 4.0 mL lavender (EDTA) tube tubes or One full 6.0 mL lavender (EDTA) tube
Neonates/Pediatrics: Two to six full lavender top microtainer tubes
Storage: Store at room temperature or refrigerate

Sample Labeling
Label the specimen in the patient's presence. The label must be legible and include the following
patient information:

 Full name (first and last)

 Date of birth (DOB)
 Social Security Number, if available
 Initials of person collecting the specimen
 Date and time of collection

Outpatient Specimen Guidelines

Non-Transfusion Specimens, Including Prenatal, Blood Types And Antibody Screens

Ask the patient to state the following patient identification information and present
picture identification, if available:

 Full name (first and last)

 Date of birth (DOB)
 Social Security Number, if available

Required Sample
Adults: Two full 4.0 mL lavender (EDTA) tube tubes or One full 6.0 mL lavender (EDTA) tube
Neonates/Pediatrics: Two to six full lavender top microtainer tubes
Storage: Store at room temperature or refrigerate
Sample Labeling
Label the specimen in the patient's presence. The label must be legible and include the following
patient information:

 Full name (first and last)

 Date of birth (DOB)
 Social Security Number, if available
 Initials of person collecting the specimen
 Date and time of collection

Preadmission Patients For Surgery

The Legacy Preadmission policy allows certain patients to be drawn for blood bank testing up to 28
days before surgery. Patients must go through the hospital Preadmission Department to be eligible.
Contact the Preadmission Department at the Legacy hospital where the surgery will be performed.

Inpatient Specimen Guidelines

Ask the patient to state the following patient identification information and present
picture identification, if available:

 Full name (first and last)

 Date of birth (DOB)
Confirm the patient's identification band, the requisition and the specimen label all match for the
following:

 Full name (first and last)

 Date of birth (DOB)
 Hospital identification number

Note: Do not collect the specimen until the identification is confirmed. A Fenwall number can
be substituted for the hospital identification number if a hospital identification number is not available
and immediate transfusion is required.

Required Sample
Adults: Two full 4.0 mL lavender (EDTA) top tubes
Neonates/Pediatrics: Two to six full lavender top microtainer tubes
Storage: Store at room temperature or refrigerate

Sample Labeling
Label the specimen in the patient's presence. The label must be legible and include the following
patient information:

 Full name (first and last)

 Date of birth (DOB)
 Hospital identification number
 Initials of person collecting the specimen
 Date and time of collection
TURNAROUND TIME

Turnaround Times for Blood Bank Products and Services for Hospital Based Patients
The following guidelines for expected response or turnaround time (TAT) have been determined by
the Blood Bank staff and Medical Director. Circumstances that may cause deviation from these
guidelines include, but are not limited to: patient identification problems, instrument malfunctions,
shortage/availability of products, heavy workload, antibody problems or delay in transportation. The
turnaround time is from the time the specimen is received in the Blood Bank.

Guidelines for Typical Blood Bank Tests, Procedures and Services for Hospital Based
Patients

Procedure/Service Routine STAT

(minimum time) (minimum time)

Blood Type 30 minutes 15 minutes

Type and Screen 2 hours 1 hour

Type, Screen, and Crossmatch 2 hours 1 hour

(negative antibody screen)

Crossmatch 20 minutes 10 minutes

(antibody screen negative)

Antibody Identification 2 hours to 2 days

(depending on complexity)
ABORh (type) Specific 30 minutes
(uncrossmatched blood)

Group O 15 minutes
(uncrossmatched blood)

FP 30-45 minutes 30 minutes

Platelets 1 hour 30 minutes

(available in-house)

Platelets 4 hours Minimum 2 hours

(must order from blood supplier)

Cryoprecipitate 30-45 minutes 30 minutes

Guidelines for Special Circumstances and Pediatrics for Hospital Based Patients
Note: For TATs for MTP/Trauma, please refer to MTP protocol 915.6149 and/or Blood Bank Policy
BB.0230.

Procedure/Service Routine STAT

(minimum time) (minimum time)

ABO, Rh, DAT 30 minutes 15 minutes

RhIG Workup and Fetal Screen 2 hours 1 hour

Antibody Titration 2 hours to 2 days

Washing RBC's 1 hour (per unit) 45 minutes (per unit)

Splitting or Dosing Products 30-45 minutes 25 minutes

ECMO Setup 1.5 hours

Exchange Transfusion 2 hours

Blood Bank Orders

Clot to Hold: Order if low likelihood of transfusion. Provides appropriately labeled blood sample
tube to the Blood Bank. Sample is good for three days.

Type and Screen: Order if low to moderate likelihood of transfusion. Provides blood type and
antibody screen. If antibody is identified, the patient will get antigen negative blood available in case
transfusion is ordered in the future. If antibody screen is negative, can crossmatch blood for patient
in 20 minutes (routine) or 10 minutes (STAT). Sample is good for three days.

Type and Crossmatch: Order if moderate to high likelihood of transfusion, or transfusion is

imminent. Provides blood type and antibody screen. Actual units are tested and set aside for the
patient. Units are kept ready for three days.
Whole Blood or Packed Cells Transfusion

Specimen Requirements

1 full 6 mL pink-top (EDTA) tube with label that includes: patient's first and last name, PF#/MR#, time,
date, printed last name of phlebotomist.

Send specimen and order form to Blood Bank immediately

 STAT (urgent) request – if type specific units are on hand in the Blood Bank, cross matched
blood will be available on 1 hour notice.
 "Type and Screen, Hold" Request

1. Specimen is ABO and Rh typed, and an antibody screen is run.

2. Crossmatch done only on notification within 72 hours of specimen date and time.
3. Units NOT cross matched and held.
4. Units can be cross matched on 10 minutes' notice.

 Scheduled surgeries

1. Blood may not be available when required if requests for this blood arrive in the laboratory
after 2:30 p.m. the day prior to surgery. Antibody problems and lack of units on hand may
preclude the availability of the blood in time for scheduled surgery.
2. When patient either has been pregnant or transfused within the past six months, or when such
information is uncertain or unavailable, a sample obtained within 72 hours of next scheduled
transfusion or surgical procedure must be sent for compatibility testing. If the patient has not
been pregnant or transfused in the last six months, a specimen may be used up to seven days,
provided a medical history form stating this information accompanies the crossmatch
requisition.

All components are to be held in the Blood Bank until they are infused into the patient. They must
NEVER be "held" in domestic refrigerators on the wards. If a unit is issued and transfusion plans have
changed or been delayed, please return it immediately to the blood bank. If returned unopened and
unused within 30 minutes of issue, it will be held in the Blood Bank refrigerators for reissue to that
patient.

If it is anticipated that the transfusion will exceed four hours, special arrangements should be made
with the Blood Bank to split the unit prior to transfusing.

Pheresis (White cell concentrate or single donor platelet concentrate)

White Cell Concentrate Specimen Requirements

1 full 6 mL pink-top (EDTA) tube with label that includes: patient's first and last name, PF#/MR#, time,
date, printed last name of phlebotomist. By appointment only. Consult with Director of Blood Bank,
ext. 5716 Platelet Pheresis Specimen Requirements (if Blood Bank does not have patient's ABO/Rh on
file): 1 full 6 mL pink-top (EDTA) tube with label that includes: patient's first and last name, PF#/MR#,
time, date, printed last name of phlebotomist.
 A platelet count must be completed before these components may be ordered. If the Platelet count is
greater than 50,000 per mm3, the request for these components must have the approval of the Blood
Bank Medical Director. Information necessary for ordering is patient diagnosis, ordering physician and
time of transfusion.

Exchange transfusion for Hemolytic Disease of the Newborn

Specimen Requirements

 Mother: 1 full 6 mL pink-top (EDTA) tube from the mother with label that includes: patient's
first and last name, PF#/MR#, time, date, printed last name of phlebotomist, and indication
that it is the "mom’s clot" for Baby ______, PF#/MR#______)
 Baby: 0.5 mL blood in a pink or lavender-top (EDTA) tube with label that includes: patient's
first and last name, PF#/MR#, time, date, printed last name of phlebotomist.
 Instructions:

1. Notify Blood Bank immediately of possible exchange.

2. It is preferable to use maternal serum for any initial antibody screening for unexpected
antibodies or for cross matching, particularly for exchange transfusion for treatment of
hemolytic disease of the newborn. If the initial test for unexpected antibodies is non-reactive,
subsequent tests to determine incompatibility with donor red cells, and repeated tests for
unexpected antibodies may be omitted for the remainder of the neonatal period. If mother’s
specimen is not available, testing should be performed on a blood sample from the baby.
3. Confirmation of baby’s blood type must be performed prior to the transfusion of any type
specific blood product.
4. Blood for infants will be supplied by preparing aliquots of units of blood no more than 35 days
old.
5. CMV negative red blood cells will be supplied for infants less than 4 months of age.

CALIBRATION PROCEDURE

List of Equipment

 Blood Bank Automation System / Automated

Blood Bank System  Mini Centrifuge

 Blood Bank Refrigerator  Plasma Freezer / Blood Bank Freezer

 Cell Washing System / Cell Washer  Platelet Aggregation Systems (Aggregometer)

Centrifuge
 Platelet Incubators
 Hematology Analyzers
 Platelet Shakers
 Laboratory Centrifuge
 Refrigerated Laboratory Centrifuge
 Microcentrifuge
 Tabletop Centrifuge
 1. Blood bank Automation System / Automated Blood Bank System
An automated blood bank system replaces manual screening tests on blood products. Used by blood donation
centers and blood transfusion sites, a blood bank automation system can run mandated tests for HIV, hepatitis B and
C, syphilis, and human T cell lymphotropic virus. Blood bank automation systems are also used to determine blood
type and cross-match donor units to a patient who needs blood with a specific phenotype. Variable between
manufacturers, features of automated blood bank systems include the types of tests it is capable of performing,
number of tests per hour, discrete and/or continuous sampling, and STAT mode availability.