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INSTRUCTIONS: Fill out items applicable in your Blood Service Facility. Write NA, if not applicable.
Cryosupernate 0 0 0 0 0
Cryoprecipitate 0 0 0 0 0
Washed RBC 0 0 0 0 0
Others 0 0 0 0 0
IV
A. No. of patients whom blood was requested
B. No. of patients who received blood5,932
C. No. of surgical cancellations due to unavailability of blood __0___
D. No. of cases delayed due to unavailability of blood __0_____
E. No. of death due to unavailability of blood __0_____
V
A. No. of errors dealing with laboratory processes
a. Labeling _____4____ c. Testing ___0_____
b. Preparation ____12___ d. Issuance _____0_____
A. Routine9,987
B. Emergency 7,084
a. Crossmatched three phases3,842
b. Crossmatched saline and albumin only 670
c. Crossmatched saline phase only2,572
d. ABO Type specific uncrossmatched0
e. Group “O” Uncrossmatched blood0
Summary/Impression
Date Blood Signs and Symptoms of
Patient’s Working Diagnosis. Transfusion Reaction
Transfused Product Transfusion Reaction
Investigation
NO BLOOD TRANSFUSION
REACTION INVESTIGATED
OCTOBER 2015 REVISED NVBSP BLOOD MONITOPRING AND
HOSPITAL BLOOD TRANSFUSION REPORT
DENNIS M. ANCHETA, MC, FPCP JOSE RAVINAR J. AUSTRIA, MD, FPSGS, MBA-H
HBTC Chairman Chief of Professional Medical Services
Approved by: