Documentation of Transfusion

Documentation requirements vary from hospital to hospital but there are a few required pieces of information that must be documented on the patient's medical record.

Documentation of the following pieces of information is important in order to trace transfusion of blood components if a new threat to the blood supply is identified:

1. Blood component name (type, e.g., RBC, pooled platelets, FFP);
2. Donation (unit) number, including centre code (i.e., three-digit centre code, one-digit check digit and six-digit serial number). Some facilities allow the use of stickers from the back of the donor unit or lot number and manufacturer;
3. ABO/Rh of the component, if applicable;
4. Time transfusion of each unit was started;
5. Signatures of the individuals identifying and initiating the transfusion;
6. Time the transfusion was discontinued;
7. Volume administered;
8. Whether a reaction to the transfusion occurred.

Pooled Blood Components

The compatibility label attached to the donor unit may contain all of the numbers of the units contained in the pool, or, when a transfusion service computer system is used, the computer may assign a "pool number" to the unit. In either case, the compatibility label should indicate the number of unit in the pooled blood component.

Do Not Remove...

The compatibility label on the blood component unit until the transfusion is discontinued.