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  • Request For Autologous Donor Blood Components - Lstream

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REQUEST FOR AUTOLOGOUS DONOR BLOOD COMPONENTS (Note this is a 2 page form; both pages are required!) Schedule appointment for all donor centers and auto van by Faxing orders to 909.386.6817 Call Toll.

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Indications and contraindications Absolute contraindications for autologous donation include: idiopathic hypertrophic sub-aortic stenosis. aortic stenosis. left main coronary artery disease.

Your blood will be tested for infectious diseases that may be transmitted through blood transfusion, including but not limited to: HIV, Hepatitis B and C, and Syphilis. If your unit tests reactive for one or more of the tested infectious agents, your physician and you will be notified.

ADVANTAGES OF AUTOLOGOUS BLOOD DONATION There is no transmission of infectious diseases. It ensures blood type compatibility, which may be of special importance for some people with rare blood types. The risk of some kinds of transfusion reactions is reduced.

You must be in reasonably good health. You will not be allowed to self-donate if you have an active infection and you may not be allowed if you have a heart condition. There is no age limitation for autologous donation, but you must weigh at least 110 pounds.

You may not donate within 72 hours of your surgery. Will my blood be tested for diseases? At this time viral and infectious marker testing is not a requirement for autologous donations when the transfusion occurs at the collecting facility. The only testing done is an ABO/Rh typing and an antibody screen.

The donor has a hemoglobin level no less than 11.0 grams of hemoglobin per deciliter of blood or a hematocrit value no less than 33 percent; and 3. The responsible physician of the blood establishment determines and documents the donor's health permits the collection procedure.

You must be in reasonably good health. You will not be allowed to self-donate if you have an active infection and you may not be allowed if you have a heart condition. There is no age limitation for autologous donation, but you must weigh at least 110 pounds.

Autologous blood transfusions are detected by an indirect method which monitors the longitudinal profile of hemoglobin concentration (Hb), reticulocyte percent (Ret%), and the Off-score, defined as Hb −60√Ret%.

Your blood will be tested before a transfusion to determine whether your blood type is A, B, AB or O and whether your blood is Rh positive or Rh negative. The donated blood used for your transfusion must be compatible with your blood type.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232