While anaemia is considered a valid indication for a blood transfusion on a blood ordering request form, the patient’s underlying diagnosis should be specified to assist with safe and efficient product delivery. This information helps Blood Bank staff follow due processes to ensure patients receive blood products best suited to their clinical condition.

The clinical diagnosis is the first step in sample receipt at the Blood Bank, serving as an alert for ultra-high-risk cases, possible causes of a weak reverse group, difficulties finding compatible blood, and positive results on a Coombs or direct antiglobulin test.

The specification of the patient’s underlying diagnosis assists the Blood Bank staff in the following ways:

  1. The primary clinical diagnosis safeguards against processing blood for patients who have been diagnosed with viral haemorrhagic fevers (VHF) and pyrexia of unknown origin. The Blood Banks have strict protocols regarding the issue of emergency blood for these patients and the proper disposal of their samples to avoid handling potentially contaminated blood.
  2. A primary clinical diagnosis will also alert Blood Bank staff to perform additional phenotyping on patients with extended transfusion regimens, such as those with sickle cell disease (SCD) and thalassaemia, to minimise alloimmunisation risk.
  3. Certain clinical diagnoses alert the Blood Bank staff to the causes of a weak reverse group, such as in patients who have Fanconi’s anaemia or carcinoma. Weak reverse grouping can also arise from low levels of gamma globulins (e.g., agammaglobulinaemia, hypogammaglobulinaemia, post-bone marrow transplant patients), sample collection issues, and age-related factors (e.g., neonates or elderly patients).
  4. The underlying diagnosis may cause positive results for a direct antiglobulin test and Coombs auto, such as in patients with tuberculosis, HIV, and autoimmune haemolytic anaemia.
  5. If an underlying diagnosis is known to cause haemolysis (such as in patients with burns or autoimmune haemolytic anaemia) and in cases of incorrect sampling technique, the Blood Bank staff will contact the clinician to explain the challenges of crossmatching and confirm that the testing can proceed using the haemolysed sample. If severe haemolysis is present and testing cannot proceed, group O red cell products and AB FFP will be issued. If the diagnosis is not associated with haemolysis, the Blood Bank staff will request a new sample and form for repeat testing.
  6. The diagnosis may also preclude a patient from an electronic crossmatch (e.g., stem cell transplant patients).

For more information about Blood Bank requirements, contact your closest Blood Bank.