Beth Israel Deaconess Medical Center Laboratory Manual

Go directly to: Transfusions , Blood Collections , Transfusion Guidelines , Special Products and Situations , Transfusion-Associated Infectious Diseases

This section of the Laboratory provides transfusion support for patients in the Beth Israel Deaconess Medical Center.

BLOOD ORDERING

Blood Bank specimens must be drawn in pink top tubes and labeled in accordance with the BIDMC Specimen Labeling Policy. To prevent potentially fatal transfusion reactions, improperly labeled specimens cannot be used for compatibility testing. Blood Bank personnel will call the patient’s providers to request a new specimen. Each full (6 ml) specimen can be used to crossmatch red blood cells for inpatients for 3 days, after which a new specimen will be required before blood can be released. Outpatient preoperative specimens may be held for up to 14 days.

Blood orders for patients undergoing elective surgery are automatically instituted at the time the procedure is booked using the hospital’s Suggested Surgical Blood Order Schedule (SSBOS). This system assigns a blood order based on customary blood use of previous patients undergoing the same procedure. Automatic orders for individual patients may be previewed using the computer or printed OR schedule. In high-risk or unusual cases, the SSBOS order may be changed by calling the Blood Bank (East campus: 617-667-4480; West campus 617-754-3300) the day before surgery.

Red blood cells and many other components are supplied by the American Red Cross, New England Region (Dedham, MA). All blood components are screened for HIV, Hepatitis B and C, HTLV I / II, West Nile virus, Chagas disease, and syphilis. Blood components are released for transfusion following completion of these tests, provided the results are negative.

In general, blood components for hospitalized patients are delivered by the pneumatic tube delivery system following receipt of a blood component pick-up form.  This form must be fully completed, including patient information, date, patient location and type and number of products.

Elective transfusions for outpatients are administered in the Infusion/Pheresis Unit (East Campus, Gryzmish 5, 617-667-1681). Transfusions should be scheduled at least 24 hours in advance; a written order and current signed informed consent are required.

"Directed donations" (for non-medical indications) are not collected at the hospital, and their use is discouraged. In unusual situations, such donations can be arranged through the American Red Cross in Dedham 781-461-2000 or 781-461-2275.

Transfusion Reactions

All suspected transfusion reactions must be reported to the Blood Bank for investigation. Reaction investigation forms, available at all nursing stations, have instructions regarding steps for a proper work-up. A blood bank physician should be contacted for questions or problems. Ordinarily, additional blood components will not be released for the patient until the investigation is completed.

1) Autologous Blood Donation Program

The Transfusion Service runs a program for the collection and transfusion of autologous blood. Patients undergoing elective surgical procedures for which blood is usually crossmatched are ideal candidates. A minimum two week interval before surgery is recommended.

An appointment for autologous donation may be made by calling 617-667-1522. A physician’s order for autologous donation is required prior to your donation.

Autologous components are routinely stored as liquid whole blood or packed cells with a 35 day shelf-life. Autologous blood is not tested for transfusion transmissible diseases, and is reserved only for the patient-donor; unused blood is discarded 48 hours after discharge unless the surgeon calls to reserve components for future use.

2) Intraoperative Autologus Blood Salvage

Intraoperative autologous blood salvage is routinely provided for patients undergoing major vascular procedures and cardiac surgery, through the Department of Cardiothoracic Surgery. Blood salvage may be arranged for other cases by calling Brian O’Connor, head of the Perfusion Team, at 617-754-2747.

The Beth Israel Deaconess Medical Center is required to investigate unexplained infectious disease in transfusion recipients for the possibility of transfusion-transmitted illness.

Such investigations are for the purpose of allowing us to identify, and permanently defer, donors carrying these viruses who escaped detection by other means, including tests for screening for hepatitis B surface antigen and HCV, HIV, or HTLV-I/II antibodies.

Please notify the Division of Transfusion Medicine of any patient who

• has developed hepatitis or a positive test for hepatitis within 12 months after receiving a blood transfusion
• has developed AIDS or has become HIV positive since receiving blood transfusions
• you are concerned has acquired a transfusion-transmitted disease.

Send notification to: luhl@bidmc.harvard.edu or Dr. Lynne Uhl, Director of Laboratory and Transfusion Medicine,
Beth Israel Deaconess Medical Center,  Room YA-309,  330 Brookline Ave. , Boston, MA 02215