Blood
Blood
Blood
DONOR RECIPIENT
CROSSMATCH NOT REQUIRED FOR THE COMPONENT REQUESTED DATE
ABO ABO REMARKS:
Rh Rh
PATIENT IDENTIFICATION – USE EMBOSSER (For typed or written entries give: Name–Last, first, middle; grade; rank; SEX WARD
rate; hospital or medical facility)
SECTION I – REQUISITION
Component Requested
"Other (Specify)" – List any whole blood or blood product not on menu, i.e., washed RBC's deglycerolized RBC's, etc.
"Volume Requested (If applicable)" – Use only when different from standard amount, i.e., exchange transfusion 50 ml.
"Known Antibody Formation/Transfusion Reaction" – Check Medical Records. Annotate N/A if appropriate.
"If Patient is Female, Is There History Of" – Check medical records. Annotate N/A if appropriate.
"Previous Record Check" – Current tests should be compared with prior records for ABO and Rh type, difficulty in blood typing,
clinically significant unexpected antibodies, and severe adverse reactions.
"Test Interpretation" – Use the following standard notations. "NEG or "POS" for antibody screen block. "COMPAT" or "INCOMPAT"
for crossmatch block.
"Pre-Transfusion Data"
This statement is to be completed by the issuing laboratory person once he/she has inspected the blood immediately before issue
from the laboratory. The blood must not be abnormal in color or appearance or expired, and if any of these conditions exist the
blood will not be used for transfusion.
"Signature" blank must contain the signature, as opposed to name, of issuing laboratory person.
The issuing laboratory person will secure this form to the blood bag by string, rubberband, or tie knotted to the tag and the blood
container before issuing the blood.
"Description of Reaction" – Check appropriate reaction or describe "other" on separate sheet, if necessary, and
attach to SF 518.
"Other Difficulties"– Check item or describe on separate sheet and attach to SF 518.