Blood Bank and Transfusion Medicine Services

Director & Clinical Consultant: James Gorham MD PhD, PIC 7827; Associate Director & Clinical Consultant: Jenna Khan MD, PIC 6074; Clinical Consultant: John Luckey MD PhD, PIC 7340; Clinical Consultant: Valery Kogler MD, PIC 2430; Blood Bank Fellow: Thomas Fennell, MD; Laboratory Manager: Thomas Brady, MT (ASCP) SBB

The Blood Bank and Transfusion Services at UVA are accredited by CAP and AABB and registered by the FDA. Blood medicine are purchased from the American Red Cross. Red cells, plasma, platelets and cryoprecipitate are routinely available. All cellular products are leukocyte reduced and irradiated. Washing and splitting of blood products can be provided when ordered. Red cell, platelet alloimmunization evaluations and transfusion reaction workups are available. The Blood Bank also performs Rotem coagulation testing. Tissue stored in the Blood Bank includes, heart valves for pediatric patients, liver vessels and bone flaps.  A Blood Bank Physician is available for hemotherapy consults and can be reached by calling the Blood Bank 924-2273 or pager number 1426.

1. UVa Health System Clinical Practice Guidelines for Transfusion

• Link to UVAHS Guideline 2.040: Blood Component Transfusion Guidelines
• Link to 2018 Fast Blood and Massive Transfusion Protocol Education

2. Medical Services Available

• Transfusion Medicine and Immunohematologic Consultation

3. Technical Services Available

a)    Immunohematologic Evaluation

b)    Platelet Alloimmunization Evaluation

4. Criteria for Transfusion of Blood Components

• See Transfusion Guidelines

5. Crossmatch Procedures

a)    Request Procedure.  Blood products are routinely requested through the electronic medical record (Epic). If Epic is not operational, an Epic Downtime Form must be submitted.  If preprinted admission labels are not available, print (ballpoint pen) the requesting physician's name, PIC #, patient's name, history number, location, and date.  Most serious transfusion accidents are caused by clerical or identification errors.  The TYPENEX system must be used properly for specimen identification.  Improperly labeled specimens and requests may be rejected by the Blood Bank staff.  Blood specimens Required: 6 mL pink top tube.  TYPENEX labels on tubes must show the patient's full name with suffix, history number, date collected, and the first initial and last name of the phlebotomist.  MISLABELLED SPECIMENS CAN RESULT IN FATAL HEMOLYTIC TRANSFUSION REACTIONS.

b)    Elective Requests.  Elective requests are filled in the order received.  If the blood reserve is reduced to the amount designated "EMERGENCY RESERVE," elective requests for which the full number of units is not available are postponed until blood is available.  When the supply is inadequate for elective transfusion, the requesting physician will be notified immediately.  If ABO/Rh type specific red blood cells are not available, ABO/Rh type compatible red blood cells may be substituted.

c)    Emergency Transfusion Requests.  In very urgent situations blood will be issued before a crossmatch is performed.  The requesting physician must submit a completed "Emergency Request for Uncrossmatched Blood" (BB:45) form certifying the urgent nature of the request.  If the patient's type is unknown and an acceptable sample is not available for testing, as many as four units of Group O, Rh negative red blood cells will be issued.  If, after these units have been issued, a sample is still not available and additional blood is requested then:

• Group O, Rh negative red blood cells will be issued to all females not past child bearing age (<50 years) and for those patients with a known history of Rh sensitization.
• All other patients will receive Group O Rh negative red blood cells only if inventory is adequate.  Otherwise, they will be issued Group O Rh positive red blood cells.
• If a current sample (< 3 days old) is available for testing, then uncrossmatched ABO compatible units may be available in approximately five minutes.

d)    Schedule. Requests for blood will be filled as follows:

• Emergency (no crossmatch)          Immediately
• Electronic crossmatch                   15 minutes
• Electronic crossmatch is a computer crossmatch with over 20 electronic checks to assure the red cell product is compatible. Patients with a current Typenexed sample, a negative antibody screen, and no history of antibodies are eligible for this rapid crossmatch.
• Anti-human globulin crossmatch, full      1 hour
• An antihuman globulin crossmatch is performed on specimens from patients with alloantibodies, or a history of alloantibodies.

e)    Type and Hold samples are held for 3 days.  For example, a sample collected at 1800, Monday will expire at 0700, Thursday.

f)     Units crossmatched with patient specimens submitted between 0700 of any day (Day 1) and 0700 of the next day (Day 2) will be held in reserve until 0700 of the following day (Day 3). Units crossmatched on Day 2 or Day 3 against a sample collected on Day 1 will be held in reserve for the patient until 0700 on Day 4.

g)    Specimens submitted for "Type and Hold" may be used to provide units of blood (either crossmatched or uncrossmatched) so long as the units are transfused within 3 days of the specimen's being obtained.

h)    Special policies exist for neonatal transfusion. Please consult with a Blood Bank Supervisor or Director.

i)      Rh-Negative Blood. The limited reserves of Rh-negative blood occasionally obligates use of Rh-positive blood for Rh-negative recipients, especially in patients needing many transfusions. Rh-negative women (with childbearing potential), and patients having Rh antibody (anti-D), should only rarely be given Rh positive blood.

6. Consent For Blood Transfusion:

a)    It is the patient's physician's responsibility to obtain informed consent from the patient, or their guardians, for the transfusion of red blood cells and other components. The consent expires after the patient is discharged.  Consents for outpatients are valid for six months. 

b)    Unless otherwise specifically indicated, informed consent is required for the administration of all components. Blood products that have been treated to inactivate or remove viruses (e.g. albumin, immune globulins, coagulation factor concentrates, and fibrin sealant) do not require informed consent.

c)    Informed consent is not required for the administration of red blood cells and other components in an emergency when delay resulting from obtaining informed consent would place the patient in jeopardy. Documentation of the urgency of the situation must be included in the patient's medical record.

d)    If a patient, or his or her guardian, refuses to give informed consent, this too must be documented, and red blood cells and other components may not be administered.

e)    The completed "Blood Transfusion Consent or Refusal" form is to be placed in the patient's chart prior to transfusion.

7. Consultation

• The Medical Directors of the Blood Bank are available for hemotherapy consultation.  A Director and Laboratory Medicine resident are always on-call and may be reached through the Blood Bank or hospital operator.

8. Additional Information

a) Cryoprecipitate information

b) Platelets information

c) Evaluating for Platelet Transfusion Refractoriness