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T&S or T&H:

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The blood bank types the patient’s blood (ABO and Rh), screens for antibodies, and holds the blood. If a rare antibody is found, the physician usually is notified. If it is likely that blood will be needed, the T&S order may be changed to a T&C.

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T&C:

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The blood bank does a T&S on the patient’s blood and matches specific donor units to the patient. The cross-match involves testing the recipient’s serum against donor blood cells. A T&C usually takes less than 1 h.

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Stat Requests:

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The bank sets up blood immediately and usually holds it for 12 h. For routine requests, the blood is set up at a date and time that you specify and usually held for 36 h.

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Voluntary blood donation is the mainstay of the blood system in the United States. Donors usually are > 18 y old, are in good health and afebrile, and weigh > 110 lb (50 kg). Donors are usually limited to 1 unit every 8 wk and 6 donations per year. Patients with a history of hepatitis, HBsAg positivity, insulin-dependent DM, IV drug abuse, heart disease, anemia, or homosexual activity are excluded from routine donation. Patients who may have transmissible diseases are counseled about high-risk behaviors that may put the recipient of the blood at risk. Donor blood is tested for ABO, Rh, antibody screen, HBsAg, anti–hepatitis B core antigen, hepatitis C antibody, anti–HIV-1 and -2, and anti–HTLV-1 and -2.

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Some patients undergoing elective surgery in which blood may be needed use preadmission autologous blood banking (predeposit phlebotomy). General guidelines for autologous banking include good overall health, HCT > 34%, and arm veins that can accommodate a 16-gauge needle. Patients can usually donate up to 1 unit every 3–7 d until 3–7 d before surgery (individual blood banks have their own specifications), depending on the needs of the planned surgical procedure. Iron supplements (eg, ferrous gluconate 325 mg PO tid) are usually given before and for several months after the donation. The use of erythropoietin in this preoperative setting is being investigated. Units of whole blood can be held for up to 35 d.

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A relative or friend can donate blood for a specific patient. This technique cannot be used in the emergency setting because it takes up to 48 h to process the blood for use.

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This system has some drawbacks: Relatives may be unduly pressured to give blood; risk factors that would normally exclude the use of the blood (hepatitis or HIV positivity) become problematic; and the routine donation of blood for emergency transfusion may be adversely affected. These units are usually stored as PRBC and released into the general transfusion pool 8 h after surgery unless otherwise requested.

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Transfusion-associated graft-versus-host disease (GVHD), a frequently fatal condition, can be minimized through the use ...

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