Attachment J NBCUS

ATTACHMENT J

2007 NBCUS CRITICAL ITEMS WEB SURVEY

1.

Provide the name, telephone number, and e-mail address of each person completing this survey:
Name

2.

Telephone No.

E-mail address

List the official name, city, state, and zip code of every institution for which data are reported on
this questionnaire.
a)
Institution Name:
Street Address

City

State

Zip

City

State

Zip

City

State

Zip

b)
Institution Name:
Street Address

c)
Institution Name:
Street Address

3.

Is your institution:
A local or regional blood center (non-hospital) that collects blood from donors and
supplies blood and components to other facilities?
A hospital-based blood bank and transfusion service that collects blood from donors
(may be only autologous or directed) and provides blood and components for
transfusion primarily to your own facility?
A transfusion service that provides blood and components for transfusion, but does
not collect blood from donors?
A local or regional blood center that collects blood from donors and supplies blood,
components, and crossmatched blood products to participating facilities (such as a
centralized transfusion service)? In this category, the service is not limited to
reference laboratory work, but includes routine transfusion service.

An independent facility that collects, processes, manufactures, stores, or distributes
cellular therapy products?
For Institutions 1-4 above:
Does your firm collect, process, manufacture, store, and/or distribute cellular
therapy products?

… Yes
… No
Does your firm collect, process, manufacture, store, and or distribute human tissue
for transplantation?

… Yes
… No
4.

Does your institution collect blood from donors? (Note: If you collect autologous units only, check
“Yes” and complete this section.)

… Yes
… No
5.

SKIP TO QUESTION 12.

How many successful collection procedures were completed by your institution in each of the
following categories in 2006? If a breakdown is not available, put the total under “Allogeneic”. Do
not count low volume or incomplete procedures.
# of Procedures
Manual Whole Blood Collections
1) Allogeneic Whole Blood…………
2) Autologous……………………….
3) Directed………………………….
# of Procedures

# of Products

Automated Collections
1) Red Cell Pheresis
a. Allogeneic red cells…………….
b. Autologous red cells…………….
c. Concurrent plasma………………
d. Concurrent plasma – jumbo……..
2) Platelet Pheresis
a. Single Donor Platelets…………..______
b. Concurrent Plasma………………_
c. Concurrent Plasma –jumbo……...______

______

d. Concurrent red cells…………….._
3) Plasma Pheresis
a. Source…………………………...
b. Jumbo FFP………………………
c. FFP………………………………
6.

How many units were processed by your institution in each of the following categories in 2006?
(For red cells, count double units resulting from double collections as two units.)
a. Number of whole blood units processed:
________________units
b. Number of red cell units (not including pediatric) processed:
_________________units

7.

How many whole blood and red cells units (combined) were released for distribution?
TOTAL

8.

How many transfusable units were produced by your institution of each of the following
components in 2006? Count double or triple units resulting from double or triple collections or
splits as two or three units.
a.
b.
c.
d.
e.
f.

9.

Plasma intended for further manufacture …….
Whole blood derived platelets ………………...
Apheresis platelets (do not include autologous,
therapeutic, or split units) ……………………..
Apheresis platelets produced from splits ……..
Cryoprecipitate ………………………………..
Granulocytes …………………………………..

_______________units
_______________units
_______________units
_______________units
_______________units
_______________units

Do you issue blood to home transfusion services or other off-site non-hospital transfusion
services, such as dialysis centers?

… Yes
… No
… Don’t Know
If yes, how many units of:
c. RBCs
________________ units
d. Platelets ________________ units
e. FFP
________________ units

10.

Do you issue blood for use by military installations?

… Yes
… No
… Don’t Know
If yes, how many units of:
a. RBCs
________________ units
b. Platelets ________________ units
c. FFP
________________ units
d. Cryoprecipitate____________ units
11.

What was the total number of allogeneic units (non-directed and directed combined) discarded
in 2006 for abnormal results on any laboratory screening test?
_________________units

12.

Is your institution directly involved in the transfusion of blood to patients or does it
serve as a transfusion service for another institution that transfuses blood?

… Yes
… No

13.

SKIP TO QUESTION 21

In 2006, how many units of allogeneic whole blood and red cells (WB/RBCs) did your institution
transfuse either directly or as a transfusion service for another institution? (Exclude directed
units transfused to the intended patients.)
Total # of

Units
Transfused

14.

Total # of
Recipients

Indicate below the total number of WB/RBC units transfused in each of the following categories
and report the number of recipients of these units.
Directed units
transfused to the
intended patient

Units transfused to
pediatric patients
(overlap possible)

Autologous units
transfused to
autologous donor

a. Number of units
b. Number of recipients

15.

In 2006, how many units of each of the following components did your institution transfuse,
either directly or as a transfusion service for another institution?
a. Whole blood derived platelets
(individual concentrates, not pools)……………….________________ units
b. Apheresis platelet packs (unit?)

………………..________________ units

c. FFP……………………..…………………………________________ units
d. Plasma, frozen within 24 hours…………………....________________ units
e. Jumbo plasma (>400 ml) …………………………________________ units
f. Plasma Cryoprecipate reduced……………………_________________ units
g. Pediatric size (100ml) single donor
and/or fresh frozen plasma…………………………________________ units
h. Cryoprecipitate AHF transfusion……………………________________ units
i. Cryoprecipitate used for fibrin sealant ………….….________________units

16.

j. Granulocyte units ……………………...…………..________________ units
How many days in 2006 was elective surgery postponed due to actual blood inventory
shortages?
__________________ days

If any, how many surgeries were postponed? (Do not
count any single patient’s surgery more than once.)
_____________ surgeries
17.

How many days was your regular or standing order incomplete?
__________________ days

18.

How many days in 2006 were you unable to meet other non-surgical blood requests
(e.g. red cells, platelets)?
__________________ days

19.

How many transfusion-related adverse reactions were reported to the blood bank in 2006?
(Count the number of occurrences that required any diagnostic or therapeutic intervention.)
__________________events

… Don’t know

If any events reported, complete the table below indicating how many of these were:
Event Description

# of Occurrences

a. Life threatening, requiring major medical intervention
following the transfusion, e.g. vasopressors, blood pressure
support, intubation or transfer to the intensive care unit?
b. Transfusion Related Acute Lung Injury (TRALI)?
c. ABO incompatible?
d. Transfusion Associated Circulatory Overload (TACO)?
e. Acute Hemolysis?
f. Delayed Hemolysis?
g. Post transfusion sepsis
h. Severe Allergic Reactions?

20.

Do you have an electronic system for tracking events (i.e. unplanned, unexpected, and undesired
occurrences)?

… Yes
… No
21.

In 2006, how many autologous and directed units of red cells and whole blood were crossed over
to the community supply?
a. Autologous………………………………………._______________units
b. Directed……..…………………………………… _______________units

22.

How many total units of red cells O positive red cells, and O negative red cells (allogeneic, nondirected) were outdated in 2006? Include only those units that were outdated while on your shelf. If
you transfuse blood, include units outdated at your institution, as well as any other institutions for
which you serve as a transfusion service.
a. All Red Cell Units outdated………………………_______________units
b. O pos red cells outdated………………………….._______________units
c. O neg red cells outdated………………………….._______________units

23.

How many units in each of the following categories were outdated in 2006? Include only those
units that were outdated while on your shelf. If you transfuse blood, include units outdated at your
institution, as well as any other institutions for which you serve as a transfusion service.
a.
b.
c.
d.
e.
f.
g.
h.

22.

Whole blood ………………….……..._______________units
Whole blood derived plasma ………..._______________units
Apheresis plasma ……………………._______________units
Whole blood derived platelets ………._______________units
Apheresis platelets …………………..._______________units
Cryoprecipitate ………………………._______________units
Directed units ………………………..._______________units
Autologous units …………………….._______________units

Does your institution collect, process, issue, or infuse hematopoietic progenitor cells (HPCs) or
other cell therapy (CT) products?

… Yes
… No
23.

Does your institution maintain an inventory of or use human tissue for transplantation?
… Yes
… No

THANK YOU FOR COMPLETING THIS WEB SURVEY!