Blood Transfusion Specimen labelling and Completion of Request Form

Inpatient Information (UHW and Whitfield Clinic)

Request form 

WRH Blood Grouping and Compatibility Testing Request Form WRH-BT-LF-015

Information required on BT Inpatient Request Form

(mandatory items for identification are indicated in bold with an asterisk*)

  • Patients FULL name (Surname, Forename)*
  • D.O.B.*
  • Hospital Number*
  • Patient Gender
  • Patient Address
  • Ward and Consultant
  • Blood Group
  • Specific Clinical Information (Diagnosis, reason for transfusion, Transfusion history/history of administration of Anti-D/Antenatal history etc. if also relevant)
  • Specific Tests requested; Group and Save/Crossmatch/ DCT
  • If Crossmatch required; Number, date and time units required,
                                          Specific transfusion requirements for individual patients i.e. If modified blood components are required i.e. CMV negative and/or Irradiated,
  • Signature of Doctor requesting tests and contact/bleep no*
  •  Signature of phlebotomist (Legible)*/ Blood track "COLLECT" sticker
  • Time and date of specimen*
  • A clear indication as to whether the tests/services requested are urgent or routine.

Specimen Bottle:

  • Type: 6ml Crossmatch EDTA vacutette (pink cap)
  • Mandatory Labelling requirements:

Samples must be taken using "Blood Track Tx PDA". This printer associated to the PDA generates a set of blood track "COLLECT" stickers which includes all mandatory details, one of which must be attached to the specimen bottle and the other to the declaration section of the Blood Transfusion Inpatient Request Form.  

Where the Blood Track Tx PDA is not available or not used the specimen bottle must be completely HANDWRITTEN; The following details are MANDATORY:

  • Patients FULL name
  • Hospital Number
  • Full D.O.B
  • Signature of Phlebotomist (Legible)
  • Time and date of Sample (where this cannot be determined from details on request form etc.)

Samples found to an addressograph label attached are not acceptable and will be rejected. 

Hospital transfusion laboratory staff are acting correctly in refusing to accept a request for grouping/compatibility testing when either the request form or the sample is inadequately labelled.

The laboratory staff will inform the ward/requesting clinician if a sample is inadequately labelled and request a new sample. 

Blood Track "Tx" PDA Devices

The Blood Track system (Haemonetics Inc.) including "Blood Track Tx" is in use at UHW. This system allows pre-transfusion sampling, blood collection and transfusion practices to be electronically recorded using dedicated hardware (Blood Track Kiosks and PDA devices), software (Blood track manager and ward enquiry) and barcoded user Identification badges.

Where pre-transfusion sampling is concerned (i.e. taking a sample for group and save/group and crossmatch) the Blood Track Tx PDA must be used save for exceptional circumstances (PDA not available for use/ Emergency situations)

It is vital that the request form is labelled prior to phlebotomy (either handwritten details or addressograph label attached to request form)
This allows positive patient identification to be carried out at the patient bedside. The Blood Track Tx device can then be used to generate a suitable "COLLECT" sticker to attach to the specimen bottle and to the declaration section of the request form.

Where a blood track "COLLECT" sticker is used in place of patient demographic details the sample will be deemed unsuitable and a repeat specimen will be required.

Antenatal/GP Information 

Request form

WRH Request for Blood Group Investigation form WRH-BT-LF-115

Required information on BT Request Form (mandatory*)

  • Patients FULL name*
  • D.O.B.*
  • Hospital Number or address if sample from G.P.*
  • Patient Gender*
  • Patient Consultant or GP
  • Clinic address or GP Address
  • Tests requested and Specific Clinical Information
  • The signature of the person completing the form and contact no.
  • Time and date of specimen*
  • Signature of phlebotomist*
  • Transfusion history/history of administration of Anti-D/Antenatal history etc. is also relevant

Specimen Bottle

  • A 6ml Crossmatch pink capped EDTA bottle.
  • All Blood Grouping samples must be HANDWRITTEN - Addressograph labels are not acceptable.

Details handwritten on the sample must include (mandatory*):

  • Patients FULL name*
  • Date of Birth*
  • Hospital Number or address if sample from G.P.*
  • Signature of phlebotomist*
  • Time and date of sample*

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