One 6.0 mL Pink top (EDTA) labeled with patient's last name, first name, medical record number, date drawn, phlebotomist's initials, and second person verifier's initials.
Utilizing READBACK VERIFICATION, the phlebotomist and a second hospital personnel verify that the patient's identifiers on his/her hospital identification bracelet match those on the blood specimen. Both persons must initial the pink top tube and, if used, the pink Transfusion Service request form.
In the outpatient setting, it is permissible for the patient to verify his/her identification.
Also acceptable: One 4 mL Purple top (EDTA) labeled as above.
Tube must be filled to at least 80% capacity.
Pre-procedure specimens may be refrigerated up to 7 days for patients who have not been transfused and not been pregnant in the preceding three months.
Forms requesting blood/components and forms accompanying blood samples from the recipient must contain sufficient information for positive identification of the recipient.
Joint Commission requires that the upper half of the Transfusion Service form be completed. This area requires the person requesting the blood or blood product transfusion and type and screen to have a justification of why the blood and/or products are being requested (check mark on the appropriate box on upper left side of the form).
This request form is considered a prescription for blood and/or blood products; to comply with the FDA, the name of both the ordering physician and the attending physician must be written on the form.
Before a specimen is used for blood grouping, typing, or compatibility testing, a qualified person in the Transfusion Service confirms that all identifying information on the request form is in agreement with that on the specimen label. If the specimen is mislabeled or unlabeled, a new specimen must be drawn.
Forms requesting blood/components and forms accompanying blood samples from the recipient must contain sufficient information for positive identification of the recipient.
Joint Commission requires that the upper half of the Transfusion Service form be completed. This area requires the person requesting the blood or blood product transfusion and type and screen to have a justification of why the blood and/or products are being requested (check mark on the appropriate box on upper left side of the form).
This request form is considered a prescription for blood and/or blood products; to comply with the FDA, the name of both the ordering physician and the attending physician must be written on the form.
Before a specimen is used for blood grouping, typing, or compatibility testing, a qualified person in the Transfusion Service confirms that all identifying information on the request form is in agreement with that on the specimen label. If the specimen is mislabeled or unlabeled, a new specimen must be drawn.
| Collection |
One 6.0 mL Pink top (EDTA) labeled with patient's last name, first name, medical record number, date drawn, phlebotomist's initials, and second person verifier's initials.
Utilizing READBACK VERIFICATION, the phlebotomist and a second hospital personnel verify that the patient's identifiers on his/her hospital identification bracelet match those on the blood specimen. Both persons must initial the pink top tube and, if used, the pink Transfusion Service request form.
In the outpatient setting, it is permissible for the patient to verify his/her identification.
Also acceptable: One 4 mL Purple top (EDTA) labeled as above.
Tube must be filled to at least 80% capacity.
Pre-procedure specimens may be refrigerated up to 7 days for patients who have not been transfused and not been pregnant in the preceding three months.
Forms requesting blood/components and forms accompanying blood samples from the recipient must contain sufficient information for positive identification of the recipient.
Joint Commission requires that the upper half of the Transfusion Service form be completed. This area requires the person requesting the blood or blood product transfusion and type and screen to have a justification of why the blood and/or products are being requested (check mark on the appropriate box on upper left side of the form).
This request form is considered a prescription for blood and/or blood products; to comply with the FDA, the name of both the ordering physician and the attending physician must be written on the form.
Before a specimen is used for blood grouping, typing, or compatibility testing, a qualified person in the Transfusion Service confirms that all identifying information on the request form is in agreement with that on the specimen label. If the specimen is mislabeled or unlabeled, a new specimen must be drawn.
| Ordering |
| Result Interpretation |
| Administrative |
Forms requesting blood/components and forms accompanying blood samples from the recipient must contain sufficient information for positive identification of the recipient.
Joint Commission requires that the upper half of the Transfusion Service form be completed. This area requires the person requesting the blood or blood product transfusion and type and screen to have a justification of why the blood and/or products are being requested (check mark on the appropriate box on upper left side of the form).
This request form is considered a prescription for blood and/or blood products; to comply with the FDA, the name of both the ordering physician and the attending physician must be written on the form.
Before a specimen is used for blood grouping, typing, or compatibility testing, a qualified person in the Transfusion Service confirms that all identifying information on the request form is in agreement with that on the specimen label. If the specimen is mislabeled or unlabeled, a new specimen must be drawn.
