Patient Name: HEOTEST, TOMMY 

Age: 34 years  Gender: M  Location: 2WB W235  01  Height: 185.4 cm  Weight: 79.5 kgs  BMI: 23.1  Serum Creatinine: ?? Date Drawn: 09/09/2011 06:35am 
Ordering Clinician: PATERSON


Select the Patient's Location for Lab Label printing:
MAIN ED   PRIORITY   ECC/Chest Pain Center

   
 
 
   
   

Additional Orders:



Indications for Transfusion:
Hct less than 21% or Hgb less than 7 g/dl
Hct less than or equal to 24 & Hgb less than or equal to 8 in a patient with coronary artery disease & unstable angina/myocardial infarction or cardiogenic shock
Rapid blood loss with greater than 30-40% of estimated blood volume not responding to appropriate volume resuscitation of ongoing blood loss
Patient has been determined to be normovolemic & there is evidence to support the need for increased O2 carrying capacity as evidenced by (specify)
Other special circumstances (specify)
Autologous pre-donated red cells - same criteria as allogeneic red blood cells
 
Transfusion Time: 

(Therapeutic Dose 1 Unit)

Special Instruction: 





Transfusion Time: 
Additional Orders:


Indications for Transfusion:
Platelet Count less than 10,000 prophylactically in a patient with failure of platelet production
Platelet Count less than 20,000 & signs of hemorrhage diathesis (petechiae, mucosal bleeding)
Platelet Count less than 50,000 in a patient with (indicate)
      Active hemorrhage
      Invasive procedure (recent, in-progress, planned)
Invasive Procedure
Platelet dysfunction (ie. Plavix) as documented by
Other (specify):
(this product requires 30 minutes to thaw)
Number of Units Requested:  


Transfusion Time: 
NOTE:  (30 minutes to thaw, 300 ml per unit) 		Additional Orders:
  
  
  
Indications for Transfusion:
Abnormal coagulation studies and significant hemorrhage
Prophylactic use for PT/APTT greater than 1.5 times the mean of the reference range
Emergent reversal of coumadin
Other special circumstances (specify):  
 
(this product requires 30 minutes to thaw)
Number of Units Requested:  


Transfusion Time: 
  		Additional Orders:
  
Indications for Transfusion:
Fibrinogen less than 100 mg/dl.
Fibrinogen less than 150 mg/dl with active hemorrhage
Other (specify):  
        
        
        
        
        
        
        
        
           
        
        
                    
Medication Name Dose Route Administer
diphenhydrAMINE [BENADRYL] prior to blood
acetaminophen [TYLENOL] ORAL prior to blood
furosemide [LASIX] IV

    
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