Blood Bank

BLOOD BANK SERVICES

St. Joseph Regional Laboratory (SJRL) has a full service Blood Bank with inventory of Pre-Leukoreduced RBC's (Packed Cells-PC), Fresh Frozen Plasma (FFP), Cryoprecipitate (CRYO), and Platelets (PLTS). Products are supplied by the Gulf Coast Regional Blood Center.

BLOOD IDENTIFICATION BANDS
SJRL uses a blood band system for any inpatient with a Type & Screen or Type & Crossmatch order. The blood band is an additional identifier for any patient receiving blood.

The red blood band is good for 72 hours from the time the specimen is drawn (with some exceptions approved by the pathologist if the patient has not been pregnant or transfused within the last 90 days.)
Yellow blood bands may be used on surgery patients presenting more than 72 hours but less than 7 days prior to their surgery if the patient has not been pregnant or transfused within the last 90 days. 

RED BLOOD CELLS
Type & Screen (T & S) orders are frequently used for surgery and other patients when the physician wants blood to be available but the probability of transfusion is low.

The physician need not specify the number of units for a T&S as all units of the patient's blood type in SJRL blood bank inventory are available for crossmatching.
When the order to transfuse is received, units of blood are pulled from the inventory stock and crossmatched.
Blood may be ready for issue in approximately 5-10 minutes if a patient has a current type & screen.
A type & screen is good for 72 hours from the time the patient is drawn. 

Type & Crossmatch (T & C) orders are used when the physician orders blood to be transfused or the probability of transfusion is great.

With a T & C, units of blood are pulled from inventory stock and designated for issue to the patient.
T & C is good for 72 hours from the time the patient is drawn.
Once a T&C or T&S has expired, the patient must be redrawn, screened for antibodies and the crossmatches repeated. 

A positive antibody screen reflexes the antibody identification process.

A minimum of two antigen negative units of blood are crossmatched for the patient with a positive antibody screen.
Delays may occur when the blood bank is attempting to find compatible, antigen negative units, if there is more than one antibody present or Gulf Coast Regional Blood Center has to aid in the search for compatible units. 

Pre-Leukoreduced red blood cells are routinely stocked. These units are beneficial whenever CMV or white blood cells might cause adverse effects. Pre-leukoreduced units are especially useful for immuno-compromised patients.

An alternate method of leukoreduction is the use of a special filter (PALL filter) designed to remove white blood cells. These filters must be ordered by the physician and obtained from the blood bank. 
 
PLATELETS
The benefit of using a platelet pheresis over pooled random donor platelets is reduced exposure to different donors.
Random donor units of platelets are pooled for ease of transfusion.
Pooling takes place only when there is an order to transfuse.
Pooling of platelets requires a minimum of 20 minutes. 
 
FRESH FROZEN PLASMA (FFP)
Fresh Frozen Plasma is maintained in the blood bank in a frozen state.
FFP is thawed only when there is an order to transfuse.
Thawing FFP requires a minimum of 20 minutes 
 
CRYOPRECIPITATE (CRYO)
Cryoprecipitate is maintained in the blood bank in a frozen state.
Multiple units of cryo are usually pooled for ease of transfusion.
Thawing and pooling of cryo takes a minimum of 30 minutes.
Thawing and pooling of cryo takes place only when there is an order to give. 

AUTOLOGOUS DONATIONS
Autologous donations are available through Gulf Coast Regional Blood Center, the supplier for SJRL. Gulf Coast draws the units, performs all testing and transports the units to SJRL.
Physician information packets on autologous donations are available through Gulf Coast at 764-5600 or
877-839-6028.
Patients may not schedule autologus donation appointments without their physician's consent. Physicians must complete and submit this form for autologus donors.
Additional information is available at Gulf Coast's website, giveblood.org. 

QUALITY IMPROVEMENT
Quality Assessment Services reviews blood and component usage monthly by physician and service. These monitors are reported quarterly at the physician department meetings. 

Component	Major Indications	Action	Not Indicated For	Rate of Infusion
Red Blood Cells, Leukocytes Removed @325 mL/unite	Symptomatic anemia, febrile reactions from leukocyte antibodies	Restoration of oxygen-carrying capacity	Pharmacologically treatable anemia Coagulation deficiency	As patient can tolerate but less than 4 hours
Red Blood Cells, Adenine-Saline Added @325 mL/unit	Symptomatic anemia with volume deficit	Restoration of oxygen-carrying capacity	Pharmacologically treatable anemia Coagulation deficiency	As patient can tolerate but less than 4 hours
Fresh Frozen Plasma @ 250 mL/unit	Deficit of labile and stable plasma coagulation factors	Source of labile and nonlabile plasma factors	Condition responsive to volume replacement	Less than 4 hours
Cryoprecipitate AHF @ 10 mL/unit	Hemophilia A, von Willebrand's disease, hypofibrinogenemia,  Factor XIII deficiency	Provides Factor VIII, fibrinogen vWF, Factor XIII	Conditions not deficient in contained factors	Less than 4 hours (Frequent repeart doses may be necessary)
Platelets (pooled)*	Bleeding from thrombocytopenia or platelet function abnormality	Improves hemostatsis	Plasma coagulation deficits and some conditions with rapid platelet destruction (e.g. ITP)	Less than 4 hours
Platelet Pheresis*	Bleeding from thrombocytopenia or platelet function abnormality	Improves hemostatis	Plasma coagulation deficits and some conditions with rapid platelet destruction (e.g. ITP)	Less than 4 hours

 
Red Blood Cells, Leukocytes Removed

@ 325 mL/unit 
  
 Restoration of oxygen-carrying capacity
 Pharmacologically treatable anemia

Coagulation deficiency
 As patient can tolerate but less than 4 hours 
 

*Should not use some microaggregate filters during infusion

Note: Hazards of blood component therapy include: Infectious diseases; septic/toxic, allergic reactions; circulatory overload and Graft vs. Host Disease (GVHD).