Plasma Protein (Fractionation) Products
Ordering Plasma Protein (Fractionation) Products
Plasma protein products may be ordered in the following ways:
- Phone request.
- Hospital Information System.
- Complete and forward to Transfusion Medicine the Hemophilia Factor Concentrates Order Form (CHR101120).
- Complete and forward to Transfusion Medicine the site specific Blood Product Order Fax Requisition (REQ9002 TM-A, REQ9002 TM-S, REQ9002 TM-F, or REQ9002 TM-P) for selected products requested at ACH, SCHC, FMC-Tom Baker Cancer Centre, and PLC patient care units without a Hospital Information System.
The following information is required in order to process the request:
- Patient legal last and first name
- Patient Personal Health Number (PHN) or Medical Record Number
- Patient location
- Type of product
- Quantity or volume required (coagulation factor concentrates require a dose)
- Requesting physician
- Priority of the request (STAT, ASAP, routine, etc.)
- Date and time the product is required
- Body weight - pediatric patients only
For selected plasma protein products, Transfusion Medicine may request the completion of additional forms in order to process the request.
All requests for IVIG for patients who have not yet received the product must have an Intravenous Immmune Globulin (IVIG) History Form - TM2038 completed. The following information is required:
- Patient demographic information (use of patient addressograph is acceptable)
- Patient legal last and first name
- Date of birth
- Patient Personal Health Number (PHN)
- Gender
- Requesting/ transfusing site and patient care unit and phone number
- Ordering information
- Requesting physician
- Physician's speciality
- Requesting physician's phone or pager number
- Date of request
- The dosage and patient test results
- Patient's diagnosis in the appropriate check box and any applicable requisite information
Incomplete or incorrect information may result in delay in blood product provision.
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