Blood requisition acceptance, issue counter management, and component inspection

Dr. Topesh Patle

Introduction

  • Blood transfusion services are an essential part of modern healthcare

  • Safe transfusion depends on strict adherence to standard operating procedures

  • Errors can occur during requisition, issue, or handling of blood components

  • Incomplete or incorrect requisition forms may lead to transfusion errors

  • Improper management of the blood bank issue counter increases the risk of mismatched transfusions

  • Failure to inspect blood components can result in transfusion of unsafe blood

  • Standardized criteria for requisition acceptance ensure correct patient identification

  • Proper issue counter management maintains traceability and cold chain integrity

  • Inspection of blood components before issue ensures quality and safety

 

Blood / Blood Component Requisition Form

1. Patient details

  • Patient name: ______________________________

  • Age: __________ years

  • Sex: ☐ Male ☐ Female ☐ Other

  • Hospital registration no. / UHID: __________________

  • Ward / ICU / OPD: __________________________

  • Bed no.: _________________________________

2. Clinical information

  • Provisional diagnosis: _______________________

  • Indication for transfusion: ____________________

  • Hemoglobin / platelet count / INR (if applicable): __________________

  • Is transfusion urgent? ☐ Routine ☐ Urgent ☐ Emergency

3. Transfusion history

  • Previous blood transfusion: ☐ Yes ☐ No

  • History of transfusion reaction: ☐ Yes ☐ No

    • If yes, specify: __________________________

  • Pregnancy history (for females): ☐ Yes ☐ No

4. Blood group details

  • Patient blood group (if known): ______________

  • Rh type: ☐ Positive ☐ Negative ☐ Unknown

5. Blood / blood component requested

(Please tick and specify units)

  • ☐ Whole blood — Units required: ______

  • ☐ Packed red blood cells (PRBC) — Units required: ______

  • ☐ Platelet concentrate — Units required: ______

  • ☐ Fresh frozen plasma (FFP) — Units required: ______

  • ☐ Cryoprecipitate — Units required: ______

6. Special requirements (if any)

  • ☐ Leukocyte reduced

  • ☐ Irradiated

  • ☐ CMV negative

  • ☐ Washed red cells

  • ☐ Other: ______________________________

7. Date and time

  • Date of requisition: ____ / ____ / ______

  • Time of requisition: __________

  • Date and time required for transfusion: __________

8. Sample details

  • Sample collected on: ____ / ____ / ______

  • Time of sample collection: __________

  • Sample label verified: ☐ Yes ☐ No

9. Requesting clinician details

  • Name of doctor: ___________________________

  • Designation: ______________________________

  • Department: ______________________________

  • Signature: ________________________________

  • Contact number: ___________________________

10. Blood bank use only

  • Requisition accepted: ☐ Yes ☐ No

  • Reason for rejection (if any): ________________

  • Blood group confirmed: _____________________

  • Crossmatch compatibility: ☐ Compatible ☐ Incompatible

  • Blood unit no(s). issued: ____________________

  • Component issued: _________________________

  • Date and time of issue: _____________________

  • Issued by (name & signature): _______________

  • Received by (name & signature): _____________

 

Criteria for acceptance of blood requisition form

A blood requisition form is a legal and medical document that authorizes the release of blood or blood components. Incomplete or incorrect forms should never be accepted.

Mandatory patient details

The requisition form must contain:

  • Patient’s full name

  • Age and sex

  • Hospital registration number / IPD or OPD number

  • Ward, bed number, or clinical location

  • Diagnosis and clinical indication for transfusion

Transfusion details

  • Type of blood component required (whole blood, PRBC, platelets, FFP, cryoprecipitate)

  • Quantity or number of units required

  • Urgency of transfusion (routine / urgent / emergency)

  • Date and time when transfusion is required

Laboratory and clinical information

  • Patient blood group (if known)

  • History of previous transfusions

  • History of transfusion reactions (if any)

  • Special requirements such as:

    • Irradiated blood

    • Leukocyte-reduced components

    • CMV-negative blood

Authorization details

  • Name, signature, and designation of the requesting clinician

  • Date and time of requisition

  • Contact number of the treating unit

Criteria for rejection of requisition form

A requisition form should be rejected if:

  • Patient identification details are incomplete or missing

  • Blood component requested is not clearly mentioned

  • Form is unsigned or unauthorized

  • Mismatch between requisition form and sample label

  • Illegible or overwritten entries

Rejected forms should be returned with proper documentation, and corrective action should be recorded.

Management of the blood bank issue counter

The blood bank issue counter is a high-risk operational area that requires strict control, documentation, and trained personnel.

Personnel and access control

  • Only trained and authorized blood bank staff should manage the issue counter

  • Entry should be restricted to prevent unauthorized access

  • Identity of the person collecting blood must be verified

Verification before issue

Before issuing blood or components, the following checks must be performed:

  • Matching of patient details on:

    • Requisition form

    • Compatibility report

    • Blood unit label

  • Verification of blood group and Rh type

  • Confirmation of crossmatch compatibility

Documentation and record keeping

  • Issue register or computerized blood bank system should be updated

  • Record details include:

    • Blood unit number

    • Component type

    • Date and time of issue

    • Patient identification

    • Name and signature of issuing staff

    • Name and signature of person receiving the blood

Cold chain maintenance

  • Blood components should be issued only in validated transport boxes

  • Temperature requirements must be maintained:

    • Red cell components: 2–6°C

    • Platelets: 20–24°C with continuous agitation

    • Plasma: frozen state until issue

Communication and counseling

  • Clear instructions should be given regarding:

    • Time limit for transfusion initiation

    • Storage conditions after issue

    • Return policy for unused blood units

 

Inspection of blood components prior to issue

Visual inspection of blood components is a mandatory safety step before issue to detect any abnormality that may compromise transfusion safety.

General inspection criteria

Each blood unit must be checked for:

  • Correct labeling and unit number

  • Integrity of the blood bag (no leaks or punctures)

  • Expiry date and storage duration

Inspection of packed red blood cells

  • Color should be uniform, dark red

  • No visible hemolysis (pink or red plasma)

  • No clots, discoloration, or turbidity

  • No excessive air bubbles

Inspection of platelet concentrates

  • Swirling should be present (indicates good platelet viability)

  • No clumping or aggregates

  • No discoloration or contamination

Inspection of fresh frozen plasma and cryoprecipitate

  • Properly frozen before thawing

  • After thawing, plasma should be clear

  • No particulate matter, turbidity, or abnormal color

Criteria for rejection of blood components

Blood components should not be issued if:

  • Hemolysis is present

  • Bag is leaking or damaged

  • Expiry date has passed

  • Evidence of bacterial contamination (cloudiness, gas formation)

  • Labeling is incomplete or mismatched

Rejected units must be quarantined and documented according to SOP.

Importance of strict adherence to SOPs

Ensures patient safety

  • Minimizes human errors during blood collection, testing, storage, and transfusion

  • Ensures the right blood component is issued to the right patient

  • Prevents fatal transfusion-related accidents

Prevents mismatched and incompatible transfusions

  • Mandates multiple verification steps for patient identification

  • Ensures accurate blood grouping and crossmatching

  • Reduces the risk of ABO and Rh incompatibility

Reduces transfusion reactions and complications

  • Helps identify unsuitable, expired, or contaminated blood components

  • Prevents acute and delayed hemolytic, febrile, allergic, and septic reactions

Maintains quality and integrity of blood components

  • Ensures correct storage temperatures and handling conditions

  • Preserves functional and biochemical quality of red cells, platelets, and plasma

Ensures accurate documentation and traceability

  • Maintains complete records from donor to recipient

  • Facilitates hemovigilance and investigation of adverse events

  • Supports internal and external audits

Enables early detection of errors and deviations

  • Identifies labeling errors, storage failures, and damaged blood bags

  • Allows timely corrective and preventive actions

Promotes uniformity and consistency in practices

  • Standardizes procedures across all blood bank staff

  • Reduces variability in technical and administrative processes

Supports regulatory and accreditation compliance

  • Ensures adherence to national transfusion guidelines

  • Meets requirements of regulatory bodies and accreditation standards

Reduces medico-legal risks

  • Provides legal protection by demonstrating adherence to approved protocols

  • Minimizes negligence-related disputes and liabilities

Improves staff accountability and training

  • Clearly defines roles and responsibilities

  • Facilitates effective staff training and performance evaluation

Enhances efficiency and resource utilization

  • Reduces wastage of blood and blood components

  • Improves workflow and turnaround time

Strengthens confidence in transfusion services

  • Builds trust among clinicians and patients

  • Enhances the overall credibility of blood bank services