Dr.

D Y Patil Medical College Hospital And Research Institute

Kadamwadi, Kolhapur**, Kolhapur- 416003, Maharashtra, INDIA

Phone:0231-2655662 Email:dyphospital_kop@dypgroup.org

Blood Issue Details

Blood Request Date : 28/12/2022 Blood Request No. : 2022/5
Cross Match Request No. : 1 Cross Match Date : 28/12/2022
Issue No. : 1 Issue Date : 28/12/2022
Patient Name : MR. B L UHID : 000003277407
Age : 40 Y OPD No. : -NA-
Gender : Male IPD No : IP/22/008077
Refe By Dr. : Dr. CHETAN SINGH Ward Name : Medicine Male General Ward
Blood Priority : PLANNED Bed No. : Medicine Male General Ward Bed 86

Blood Issue Details

Blood Bag Blood Coll. Blood Exp. Patient Blood Bag Blood
Sr.No. Seg. No. Component Name Compatibility
No. Date Date Group Group
ABO ABO Major Minor IAT Other
Cryoprecipita
1 Cryoprecipitate te-DYPBC22- 28/12/2023 A1 Rh Positive A1 Rh Positive No No
3
Fresh Frozen
Fresh Frozen Plasma
2 Plasma FFP- 27/12/2023 A1 Rh Positive A1 Rh Positive No No
FFP
DYPBC22-1

Blood Bank Technician Date & Time Issued By Date & Time Blood Bank Officer
Blood Bank Admin 28/12/2022 05:08 PM Blood Bank Admin 28/12/2022 05:11 PM

Received By : Name Signature Date & Time

Printed Date :12/10/2023 09:02 PM Page Number: 1 of 2

 BLOOD TRANSFUSSION RECORD / FEED BACK FORM
( TO BE SUBMITTED IN CASE OF TRANSFUSSION REACTIONS IMMEDIATELY or NIL REPORT AFTER DISCHARGE TO BLOOD BANK POSITIVELY)

Cross Match No. : 1 Date : 28/12/2022

Name of the Patient : MR. B L

Blood Group : A1 Rh Positive Age/Sex : 40 Y / Male

Dr. D Y Patil Medical College Hospital
Hosp : And Research Institute Ward : Medicine Male General Ward I.P. No. : IP/22/008077

Blood Bag No. & Type of Component : Cryoprecipitate-DYPBC22-3 - Cryoprecipitate

Transfussion Started on & at : Completed on & at :

IN CASE OF REACTION WHEN STARTED ON & AT :

Amount of blood transfused (in ml) :

Clinical Features Pre Transfusion During Transfusion Post Transfusion

General Condition
Pulse
Respiration
Temparature
B.P.
Regor
Chilsa
Uterica
Other Observation & Components

1. Name, Age, Sex, I.P. No. & Blood group & Rh type checked and found CORRECT / NOT FOUND CORRECT in case sheets lable on blood bag and cross match reports.
2. Sent Plan EDTA Sample and Remaining Blood with blood bag and Transfusion set to Blood Bank on & at

Ward Staff Nurse Resident Clinician

Printed Date :12/10/2023 09:02 PM Page Number: 2 of 2