Blood Bank Use Cases¶

Implementation Note: Blood bank integration follows NACO (National AIDS Control Organization) and SBTC (State Blood Transfusion Council) guidelines. Supports blood requisition, cross-matching, issue, and transfusion reaction reporting.

UC-BB-001: Blood Requisition¶

Purpose: Request blood/blood products for patient with clinical indication.

Property	Value
Actor	Physician / Nurse
Trigger	Blood transfusion needed
Priority	P0

Main Success Scenario:

1. Create blood request:
   - Patient demographics
   - Blood group (if known)
   - Diagnosis requiring transfusion
   - Type of product (Whole blood, PRBC, FFP, Platelets)
   - Quantity required
   - Urgency (Routine/Urgent/Emergency)
2. Clinical justification:
   - Hemoglobin/HCT level
   - Active bleeding status
   - Surgical requirement
3. Transfusion history check:
   - Previous transfusions
   - Known antibodies
   - Previous reactions
4. Submit to blood bank
5. Blood bank acknowledgment:
   - Request ID
   - Estimated availability
   - Sample collection requirements
6. Notify requesting physician

Acceptance Criteria: 1. [ ] Clinical indication mandatory 2. [ ] Previous reaction alert 3. [ ] Request tracking 4. [ ] Urgency-based prioritization 5. [ ] Audit trail for requests

India-Specific: - NACO guidelines compliance - Rational blood use checklist - Thalassemia/sickle cell patient flagging

UC-BB-002: Blood Sample Collection¶

Purpose: Collect and label blood sample for cross-matching.

Property	Value
Actor	Phlebotomist / Nurse
Trigger	Blood requisition placed
Priority	P0

Main Success Scenario:

1. Receive sample collection task
2. Patient identification:
   - Verify name, DOB, MRN
   - Wristband verification
   - Ask patient to state name
3. Collect sample:
   - Draw blood (EDTA/Plain tube)
   - Correct volume
4. Label at bedside:
   - Patient name, MRN
   - Date, Time of collection
   - Collector ID
   - Requisition barcode
5. Complete collection form:
   - Patient signature/thumbprint
   - Collector signature
6. Transport to blood bank:
   - Cold chain maintenance
   - Chain of custody documentation
7. Blood bank sample receipt

Acceptance Criteria: 1. [ ] Two-patient-identifier verification 2. [ ] Bedside labeling enforcement 3. [ ] Sample rejection criteria 4. [ ] Chain of custody tracking 5. [ ] Sample validity period

UC-BB-003: Blood Grouping & Cross-Match¶

Purpose: Determine patient blood group and find compatible blood units.

Property	Value
Actor	Blood Bank Technician
Trigger	Sample received at blood bank
Priority	P0

Main Success Scenario:

1. Receive and log sample:
   - Verify labeling
   - Check sample quality
   - Reject if inadequate
2. Perform ABO grouping:
   - Cell grouping (Anti-A, Anti-B)
   - Serum grouping (A cells, B cells)
   - Confirm group
3. Perform Rh typing:
   - D antigen testing
   - Weak D if indicated
4. Antibody screening:
   - Indirect Coombs test
   - Panel if positive
5. Cross-match:
   - Select compatible units
   - Immediate spin / Full crossmatch
   - Compatibility confirmed
6. Update patient record:
   - Confirmed blood group
   - Antibody status
7. Issue compatibility report

Acceptance Criteria: 1. [ ] Dual verification of results 2. [ ] Antibody identification 3. [ ] Previous records concordance 4. [ ] ABO discrepancy resolution 5. [ ] Electronic cross-match (if eligible)

UC-BB-004: Blood Unit Issue¶

Purpose: Issue compatible blood unit to patient location.

Property	Value
Actor	Blood Bank Staff
Trigger	Cross-match complete
Priority	P0

Main Success Scenario:

1. Verify issue request:
   - Authorized requester
   - Cross-match validity (48-72 hours)
2. Select unit for issue:
   - Compatible unit ID
   - Check expiry
   - Visual inspection
3. Pre-issue verification:
   - Unit ID matches crossmatch
   - Patient ID confirmed
   - ABO/Rh compatible
4. Document issue:
   - Issue time
   - Issuing staff
   - Receiving staff signature
5. Transport guidelines:
   - Cold chain maintenance
   - 30-minute transfusion start limit
6. Update inventory
7. Start transfusion clock

Acceptance Criteria: 1. [ ] Double-check issue verification 2. [ ] Cold chain compliance 3. [ ] Time-to-transfusion tracking 4. [ ] Unit traceability 5. [ ] Unused unit return protocol

UC-BB-005: Transfusion Administration¶

Purpose: Administer blood transfusion with monitoring and documentation.

Property	Value
Actor	Nurse
Trigger	Blood unit received at ward
Priority	P0

Main Success Scenario:

1. Pre-transfusion checks:
   - Two-nurse verification
   - Patient ID match
   - Unit label match
   - Blood group match
   - Expiry date check
   - Visual inspection
2. Capture baseline vitals:
   - Temperature, Pulse, BP
   - Respiratory rate
3. Start transfusion:
   - Appropriate IV access
   - Blood warmer if needed
   - Initial slow rate (15 min)
4. Monitoring:
   - Vitals at 15 min
   - Hourly during transfusion
   - Complete within 4 hours
5. Document transfusion:
   - Start time, End time
   - Volume transfused
   - Any adverse events
6. Post-transfusion:
   - Final vitals
   - Unit bag disposition
   - Response assessment

Acceptance Criteria: 1. [ ] Two-person verification mandatory 2. [ ] Baseline vital documentation 3. [ ] Timed monitoring alerts 4. [ ] 4-hour completion alert 5. [ ] Reaction recognition prompts

UC-BB-006: Transfusion Reaction Reporting¶

Purpose: Document and report adverse transfusion reactions.

Property	Value
Actor	Nurse / Physician
Trigger	Suspected transfusion reaction
Priority	P0

Main Success Scenario:

1. Recognize reaction signs:
   - Fever, Chills, Rigors
   - Urticaria, Itching
   - Dyspnea, Hypotension
   - Back pain, Hemoglobinuria
2. Immediate actions:
   - STOP transfusion
   - Maintain IV access (saline)
   - Notify physician immediately
3. Clinical management:
   - Treat symptoms
   - Supportive care
4. Documentation:
   - Time of reaction
   - Signs and symptoms
   - Actions taken
   - Patient outcome
5. Blood bank notification:
   - Return blood bag and tubing
   - Send fresh samples
   - DAT, repeat grouping
6. Complete reaction form:
   - NACO transfusion reaction format
   - Submit to blood bank
7. Investigation and root cause:
   - Blood bank investigation
   - Report to transfusion committee

Acceptance Criteria: 1. [ ] STOP transfusion protocol 2. [ ] Reaction type classification 3. [ ] Mandatory reporting form 4. [ ] Blood bank auto-notification 5. [ ] Quality review trigger

India-Specific: - NACO adverse event reporting - Hemovigilance program compliance - Transfusion committee review

UC-BB-007: Blood Inventory Management¶

Purpose: Track blood unit inventory, expiry, and availability.

Property	Value
Actor	Blood Bank Manager
Trigger	Inventory operations
Priority	P1

Main Success Scenario:

1. Receive blood units:
   - From collection camps
   - From blood centers
   - Inter-hospital transfer
2. Register units:
   - Unit ID, Donation date
   - Blood group, Rh
   - Component type
   - Expiry date
   - Test results (HIV, HBV, HCV, Syphilis, Malaria)
3. Storage location:
   - Temperature-controlled storage
   - FIFO management
4. Monitor inventory:
   - Current stock by group
   - Near-expiry alerts (3 days)
   - Critical shortage alerts
5. Expiry management:
   - Prioritize near-expiry for issue
   - Inter-hospital transfer if surplus
   - Discard expired units (witnessed)
6. Reporting:
   - Daily inventory report
   - Usage statistics
   - Wastage analysis

Acceptance Criteria: 1. [ ] Real-time inventory dashboard 2. [ ] Temperature monitoring integration 3. [ ] Expiry alert system 4. [ ] Wastage tracking 5. [ ] Shortage prediction

UC-BB-008: Emergency Blood Release¶

Purpose: Release uncross-matched blood in life-threatening emergencies.

Property	Value
Actor	Blood Bank / ED Physician
Trigger	Massive hemorrhage emergency
Priority	P0

Main Success Scenario:

1. Emergency request received:
   - Massive transfusion protocol (MTP)
   - Unknown blood group emergency
2. Physician authorization:
   - Verbal order (documented)
   - Emergency consent
3. Release uncross-matched blood:
   - O-negative PRBC (universal donor)
   - AB-positive plasma (if needed)
4. Document emergency release:
   - Time of request and release
   - Authorizing physician
   - Units issued
5. Parallel processing:
   - Collect sample for grouping
   - Start cross-match
   - Switch to type-specific when available
6. Track all emergency releases:
   - Outcome audit
   - Protocol compliance review

Acceptance Criteria: 1. [ ] O-negative inventory reserve 2. [ ] MTP activation workflow 3. [ ] Emergency documentation 4. [ ] Switch to type-specific protocol 5. [ ] Post-event review

Document Owner: Blood Bank Medical Officer / IT Lead
Last Updated: 2024-12-09
Related: OT Surgery | Alerts | Bed Management