OR Blood Workflow

Guideline · Aug 2019 · 2 min read

In brief

Overview of blood product management workflow in the operating room, covering ordering, administration, and documentation protocols for surgical transfusions.

Written by the GCMD Library team from the guideline.

Patient with Prior ABO/Rh Type at CCHMC

For patients with existing blood type on file, timing of type and screen (T&S) depends on likelihood of transfusion and recency of prior sample. If prior ABO/Rh within 72 hours and no antibody history, blood can be ready in 5 minutes via electronic crossmatch; samples older than 72 hours require 60 minutes for preparation.

Patient Never Typed at CCHMC (Two Samples Required)

Patients without prior ABO/Rh typing require two separate blood samples for safety verification. First sample should ideally be drawn before surgery day; if both samples drawn same day without antibody history, blood ready in 5 minutes after second sample completes, otherwise up to 90 minutes may be needed for serologic crossmatch and HaemoBank stocking.

Timing and Location of Sample Collection

Sample collection location (Same Day Surgery unit vs. operating room) depends on clinical urgency and transfusion likelihood. Drawing samples in SDS before surgery allows faster blood availability, while OR collection may be appropriate for low-risk cases or when clinical situation changes unexpectedly.

Electronic vs. Serologic Crossmatch Eligibility

Patients without current or historical RBC antibodies qualify for electronic crossmatch with blood available from HaemoBank in approximately 5 minutes. Presence of RBC antibodies requires serologic crossmatch, which can delay blood preparation from 60 minutes up to 24 hours depending on antibody complexity.

Blood Availability Timeline Based on Sample Status

Blood availability ranges from 5 minutes (recent sample, no antibodies, electronic crossmatch) to 90+ minutes (first-time typing same day, serologic crossmatch needed). The 72-hour window for sample validity is critical—samples within this timeframe enable 5-minute turnaround, while older samples require 60-minute processing even without antibodies.

Statements in this guideline

If a patient has a prior ABO/Rh type at CCHMC and a type and screen is drawn in same-day surgery with no history of RBC antibodies, blood is ready in 5 minutes.
Established
If a patient has no prior ABO/Rh type at CCHMC and a type and screen is drawn in same-day surgery with no history of RBC antibodies, blood is ready in 60 minutes.
Established
If a patient has a prior ABO/Rh within 72 hours and a type and screen is drawn in the OR with no history of RBC antibodies, blood is ready in 5 minutes.
Established
If a patient has a history of RBC antibodies, blood preparation could take 60 minutes up to 24 hours and the blood bank should be contacted.
Recommendation
For a patient who has never had ABO/Rh typing at CCHMC, two samples are required.
Established
If the first type and screen sample is drawn in same-day surgery and the second sample is drawn in same-day surgery with no history of RBC antibodies, blood is ready in 5 minutes.
Established
If the first type and screen sample is drawn in the OR and products are needed, draw the second sample in the OR; if no history of RBC antibodies, blood is ready in 5 minutes.
Recommendation
If ABO/Rh type is known before day of surgery and a second blood bank type and screen is drawn within 72 hours of surgery with no current or history of RBC antibodies, electronic crossmatch is eligible and blood can be remotely issued from HaemoBank in approximately 5 minutes.
Established
If ABO/Rh type is known before day of surgery and a second blood bank type and screen is drawn same day as surgery with no current or history of RBC antibodies, electronic crossmatch is eligible and blood is ready in 5 to 60 minutes.
Established
If a patient has current or history of RBC antibodies, there will be a delay in preparing blood and the blood bank should be contacted for estimated time of availability as serologic crossmatch will be needed.
Recommendation
If the first blood bank sample is drawn day of surgery and a second type and screen is also drawn same day with no RBC antibodies, the second sample will take approximately 5 minutes and the patient will be electronic crossmatch eligible with blood available as soon as the second sample is complete and after the blood bank has time to stock HaemoBank.
Established
If only one type and screen is on record, there will be a delay in preparing blood of approximately 90 minutes as serologic crossmatch will be needed in the blood bank and to stock HaemoBank.
Established
If the first sample was within 72 hours of surgery, blood is available in 5 minutes.
Established
If the first sample was greater than 72 hours before surgery, blood is available in approximately 60 minutes.
Established

Full text

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

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