Forms

• IVIG Request Form
• Final Disposition of Transported Blood Components
• Transfusion Reaction Information for Patients (607757)

Resources

• CABO (Second Blood Group) Patient Letter
• Handling and Transporting Blood Components and Products
• TM Lab Phone & Fax Numbers
• Cord Blood Testing Algorithm
• Neonatal Cord Blood Testing - MNCY SCN
• Stem Cell Transplant Patients – Connect Care Blood Groups & Transfusion Requirements

IVIG Resources

• IVIG Request Form
• Criteria for the Clinical Use of Immune Globulin
• IVIG Adult Infusion Rates
• IVIG Pediatric Infusion Rates
• IVIG Dosing based on Adjusted Body Weight Calculation

Resources

• Blood Bank Pickup Form
• Order Entry for Transfusion Medicine – Category BBK
• Temperature Monitored Equipment Alarm Response Process
• Client resource for unmatched blood
• Managing Bleeding Patient Protocol in Rural Sites
• Midwife Postpartum and Cord Blood Specimen Handling (Grande Prairie)
• Red Cell Screening Algorithm
• Transfusion of Blood Products and Components Documentation Tool

Forms

• AHS Edmonton Zone Frozen Plasma (FP) Request Form (Click here to see Plasma Guidelines)
• Prothrombin Complex Concentrate Request Form
• Transfusion Medicine Requisition

Resources

• Massive Hemorrhage Protocol
  • Policy and Procedure
  • Flowchart: MHP Activation
  • Flowchart: Greater than or equal to 50 kg
  • Flowchart: Less than 50 kg
  • Cheat Sheet  (**Updated May 24, 2019)
  • Debrief Form
• RBC Screening FAQs
• Handling Blood Components and Products by Pneumatic Tube
  • Receipt and Handling of Blood Components and Products via Pneumatic Tube
  • Pneumatic Tube Decontamination

Forms

• IVIG Request Form

Resources

• Blood Component/Product Administration Quick Reference: Adult
• Massive Hemorrhage Protocol – Red Deer Regional Hospital Centre ONLY

Resources

• Blood Component Compatibility and Handling Information
• Handling and Transporting Calgary MTP Packs 
• Testing and Availability Times for Blood Components
• Completing the RTSIS Form
• Checking the tag to the bag
• IVIG Reaction Chart
• Specialized Blood Component Eligibility
• Satellite Blood Storage Refrigerator Instructions
• Dispense of Blood Components & Products Form
• Packing of Blue Platelet Containers
• Calgary PCC Dosing Protocol
• Instructions for Patient Pick Up of Rh Immune Globulin
• Identification Band for Pretransfusion Blood Testing Patient Information
• Adverse Reactions to Blood Products Notification

Massive Transfusion Protocols

• Foothills Medical Center MTP Flowchart
• Peter Lougheed Center MTP Flowchart
• Rockyview General Hospital MTP Flowchart
• South Health Campus MTP Flowchart
• Alberta Children’s Hospital MTP Flowchart

SCIG Clinic

Information for Physicians

• SCIG Physician Flyer
• SCIG Patient Referral Form
• Consent to Treatment plan or procedure AHS 09741
• Hizentra™ Product Information Monograph
• Cuvitru® Product Information Monograph

Information for Patients

• SCIG Patient Brochure
• SCIG Patient Handbook
• SCIG Patient Home Infusion Log

Resources

• Massive Transfusion Protocol – CRH
• Massive Transfusion Protocol – MHRH
• Blood Components and Products Administration Tubing Sets (South Zone West)
• Transfusion Service Identification Number (TSIN) Wristband
• Obtaining and Returning Blood Components and Products
• Blood Transfusion Reaction Report (Form 14729) – Medicine Hat & Area