King Fahd Hospital of The University, Al-Khobar

Blood Bank and Transfusion Medicine Services

Laboratory Medicine Department
Blood Component Receiving Log
ABO/RH TTD Plt RESULT for
Visual RECEIVED SEGM. RESULT bacterial detection
Unit Blood Inspection Tempe. Shipped RE TYPE CHECK After 48 HRS AFTER FINAL
Component O
No. Group OK? C From Date / Date / PREPARATION if DISPOSITION
Date Time applicable
Initial Sign Sign

□YES □NO
□YES □NO

□YES □NO

□YES □NO

□YES □NO

□YES □NO

□YES □NO

□YES □NO

□YES □NO

□YES □NO

□YES □NO

□YES □NO

Temperature Accept -Fresh Frozen Plasma/ Cryoprecipitate -18 TO -30 OC -Packed RBC 1 TO 10 OC -Platelets 20 TO 24OC

Transported by:……………………………………………………………………………….. REVIEWED BY BLOOD BANK SUPERVISOR / SIGN:………………………….

Sign & Date:……………………………………….

Lab.Med.FRM-BB&TMS012