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    Blood Transfusion Form

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    Fitz Gerald Castillo
    This document is a blood transfusion form from St. James Hospital for patient Cecilia Batad. It details that she will receive two units of packed red blood cells that are blood type A Rh positive. Both units were collected on August 11, 2017 and expire on September 15, 2017. Testing showed the blood was compatible for transfusion.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Blood Transfusion Form

    Uploaded by

    Fitz Gerald Castillo
    104 views1 page
    This document is a blood transfusion form from St. James Hospital for patient Cecilia Batad. It details that she will receive two units of packed red blood cells that are blood type A Rh positive. Both units were collected on August 11, 2017 and expire on September 15, 2017. Testing showed the blood was compatible for transfusion.

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    blood transfusion form

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    This document is a blood transfusion form from St. James Hospital for patient Cecilia Batad. It details that she will receive two units of packed red blood cells that are blood type A Rh positive. Both units were collected on August 11, 2017 and expire on September 15, 2017. Testing showed the blood was compatible for transfusion.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    104 views1 page

    Blood Transfusion Form

    Uploaded by

    Fitz Gerald Castillo
    This document is a blood transfusion form from St. James Hospital for patient Cecilia Batad. It details that she will receive two units of packed red blood cells that are blood type A Rh positive. Both units were collected on August 11, 2017 and expire on September 15, 2017. Testing showed the blood was compatible for transfusion.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    ST.

    JAMES HOSPITAL
    VQR MEDICAL FOUNDATION
    Vigan City
    Tel.no: (077) 674-0830
    CLINICAL LABORATORY
    BLOOD TRANSFUSION FORM

    Name of Recipient: BATAD, CECILIA G. Ward / Room No.: 304 Date: 17-AUG-2017
    Recipients Identification No.: ________ Age: 58 Sex: F Blood Type: A Rh POSITIVE

    Donor No / ABO / Rh Collection Expiration Date


    Source Component Date
    17-5782 / MMMH & MC A RH POSITIVE WB 8-11-2017 9-15-2017
    17-5775 / MMMH & MC A RH POSITIVE WB 8-11-2017 9-15-2017

    Component / Blood Type Requested: A Rh POSITIVE Requesting Physician: DR. RAFANAN


    ( ) Whole Blood (WB) ( ) Platelet concentrate
    ( X ) Packed Red Blood Cells (PRBC) ( ) Cryoprecipitate
    ( ) Fresh Frozen Plasma ( ) Others (specify)_ ____
    -
    Result of Compatibility Testing: COMPATIBLE ( 3 Phases)

    Crossmatching Done By: ____________________________ Date: 17-AUG-2017


    Medical Technologist

    ( ) Emergency Testing ( ) Cross-matched:


    ( ) Uncrossmatched [ ] Saline Phase Only
    (X) ABO / Rh Compatible [ ] Saline & Albumin Phase Only
    [X] Saline, Albumin & Anti-globulin Phase

    Modesty M. Alejandro-Leao,MD,FPSP
    Pathologist

    DONOR NUMBER BLOOD UNIT APPEARANCE OF TRANSFUSION TRANSFUSION TRANSFUSION


    RECEIVED BY: UNIT CHECKED BY: STARTED BY: COMPLETE SET REMOVED
    DATE / TIME DATE / TIME DATE / TIME DATE / TIME BY:
    DATE / TIME
    17-5782
    17-5775

    Remarks: ( ) Transfusion completed without immediate transfusion reactions noted.


    ( ) Transfusion stopped with transfusion reactions noted.
    ( ) Fever ( ) Nausea ( ) Flushes
    ( ) Chills ( ) Vomiting ( ) Rashes
    ( ) Others: (specify) _________________

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