Completing the Blood Transfusion Request Form

The request form must be fully completed by a registered medical practitioner. It is the clinician’s responsibility to ensure that any special requirements e.g. CMV negative, irradiated products, bone marrow transplant or solid organ transplant - are communicated to the Blood Transfusion Department. The clinical indication for transfusion should be written in the patient’s case notes and on the request form (which should comply with local and national guidelines).

The details on the request form are important and could have medico-legal implications. The request form should be clearly handwritten. An addressograph label may be used on the request form for the patient identifiers but all other details/information must be handwritten. The correct request form must be used. There are three request forms as follows:

• Antenatal Serology
• Neonatal Serology
• Routine Blood Transfusion Request Form

Specimens and Request forms for Blood Transfusion / Antenatal Serology / Kleihauer requests MUST meet minimum labelling requirements (See Essential Information)

Essential Information

The request form MUST contain the following information: 

• Patient details e.g. Surname, first name, gender, DOB and patient identification number. (If the patient details are unknown click here).
• ward or location and consultant-in-charge
• diagnosis or operation and reason for transfusion
• “high risk” sticker if appropriate
• transfusion history – ask the patient for details and check the case notes; the date, time and number of units transfused should be documented
• previous pregnancies
• number and type of blood components required or batch products, including any special requirements
• date and time products are required
• signature of person authorising the request
• name and surname (printed) of person authorising the request

The request form MUST be signed by a medical officer responsible for the patient and all details must be completed.

It is important that the name of the doctor is printed legibly. It is good practice to provide a contact number so that any problems that arise may be discussed with the relevant medical team – Blood Transfusion Department staff and the Clinical Haematologist are available for advice if required.

Suitably trained and competency assessed staff may collect samples for pre-transfusion testing. However, they must comply fully with appropriate Trust policies which are included in the ‘Trust Phlebotomy Training Package’. A copy of this policy is also given to all staff completing the course. Inadequate patient identification or sample labelling may lead to fatal ABO incompatible transfusions.

All staff responsible for pre-transfusion sample collection must undergo additional yearly reassessments, that happen three times a year and are recorded. In line with the requirements set out by the NSPA (SPN14), right patient, right blood.

Computer system failure

In situations where the computer is unavailable, A/E numbers may be used. Please note the full A/E number must be written on the sample and form. It is important that the sex of the patient and the approximate age is stated as it may influence the selection of blood and blood products.

For further clinical information please refer to the trust individual blood component guidelines located on the Trust Approved Documents website and Blood Products sharePoint.

This webpage was reviewed and updated by Mark Taplin, Blood Transfusion Manager, 22nd February 2024

In situations where the identity of the patient is not known (unconscious patient in A&E Department or an major accident) special identity numbers are used - such as, unknown patient 123.

Blood cross matched and labelled for these unknown patients may be transfused to the patient even when the patient’s true identity is known. As long as the “unknown details” wristband remains on the patient, this can happen. If the “unknown” wristband is removed, a new sample with the patient’s details is required to provide further blood and blood products.

It is important that the sex of the patient and the approximate age is given as it may influence the selection of blood and blood products especially in the case of women and (some) non-binary and trans people, of child-bearing age.