OR Blood Workflow

Patient has Prior ABO/Rh Type at CCHMC(Ever) Patient with Likelihood of Needing Blood (Would Routinely get Type and Cross)Yes No Blood Products Needed at Start of CaseYesNo Prior ABO/Rh within 72 hoursYesNo Draw T&S in SDS, if no history of incompatibility (RBC antibodies) blood ready in 5 minutesDraw T&S in SDS, if no history of incompatibility (RBC antibodies) blood ready in 60 minutesPrior ABO/Rh within 72 hoursYesNoDraw T&S in OR, if no history of incompatibility (RBC antibodies) blood ready in 5 minutesDraw T&S in SDS, if no history of incompatibility (RBC antibodies) blood ready in 60 minutes Consider T&S in OR if Clinical Situation Warrants If history of incompatibilities (RBC antibodies) could take 60 min up to 24 hours, contact Blood Bank Updated 1/2019 Patient has NEVER had ABO/Rh at CCHMC(Will Need Two Samples)Can First Sample be Drawn Prior to Day of Surgery?Yes No Process Simplified, Proceed to Algorithm for Patient with Prior Sample 1stT&S Sample Drawn in SDS Patient with Low Likelihood of Needing Blood (Would normally just get T&S) Patient with Likelihood of Needing Blood (Would Routinely get Type and Cross)No Yes Blood Products Needed at Start of Case YesDraw 2ndSample in SDS, if no history of incompatibility (RBC antibodies) blood ready in 5 minutesNoDraw 2ndSample in OR, if no history of incompatibility (RBC antibodies) blood ready in 5 minutes NoConsider T&S in OR if Clinical Situation Warrants/Will Need Two Samples if Blood Needed Yes1stT&S Sample Drawn in ORIf Products Needed draw 2ndsample in OR, if no history of incompatibility (RBC antibodies) blood ready in 5 minutesIf history of incompatibilities (RBC antibodies) could take 60 min up to 24 hours, contact Blood Bank Updated 1/2019 ABO/Rh type known before day of surgery? (previous 1stsample-T&S) No Yes 2ndBB T&S before day of surgery? Yes, w/in 72h of surgery No, drawn same day as surgery Current or history of RBC antibodies? Electronic xmatch eligible, can remotely issue blood from HaemoBank-blood ready in ~5min Yes No Delay in preparing blood, contact blood bank for ETA –will need serologic xmatch Current or history of RBC antibodies? Electronic xmatch eligible, can remotely issue blood from HaemoBank-blood ready in 5-60 min Yes No Delay in preparing blood, contact blood bank for ETA –will need serologic xmatch 1stBB sample (T&S) drawn day of surgery No, only 1 T&S on record2ndBB T&S also drawn same day of surgery? Yes2ndsample will take ~5min. As long as no RBC antibodies, patient will be electronic xmatch eligible and blood available as soon as 2ndsample complete and after BB has time to stock Haemobank. Delay in preparing blood, contact blood bank for ETA (~90min) -will need to serologic xmatch in blood bank and to stock Haemobank. If 1st sample was w/in 72h of surgery then blood available in 5 min If 1st sample was > 72h of surgery then blood available in ~60 min Delay in preparing blood, 1stT&S will take ~60min to complete Updated 1/2019