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Provides specimen instructions including acceptable sample types, required anticoagulants, cold-chain handling, and delivery time limits. Includes sections for hospital and patient details, sample collection timing, requested test selection, compatible product type restrictions, delivery urgency (STAT/ASAP/ROUTINE), and special requirements such as CMV-negative or irradiated products. Contains QC reference use fields for receipt status and comments.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ny-frm-0451-testing-request-form-platelet-antibody-screen-cross-matched-platelets-instructions/203516/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ny-frm-0451-testing-request-form-platelet-antibody-screen-cross-matched-platelets-instructions/203516.png","ImageObject",300,407,{"name":92,"@type":93},"Fahsai","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-20","2026-09-04",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What specimen types and timing are accepted for the platelet antibody screen and cross-matched platelets test?","Question",{"text":112,"@type":113},"Acceptable specimens are two tubes of whole blood (no gel) or 4 mL serum/plasma. Samples must be transported cold and must be less than 48 hours old when received for testing.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How should specimens be labeled and sent to the laboratory?",{"text":117,"@type":113},"Label all specimens clearly with last name, first name, date of birth, and date drawn. Fax the completed form, then send specimens with a copy of the form to the Rye QC/Reference Laboratory address provided.",{"name":119,"@type":110,"acceptedAnswer":120},"Which delivery options and special requirements can be selected for the requested platelet product?",{"text":121,"@type":113},"Delivery urgency options include STAT, ASAP, and ROUTINE. Special requirements include CMV-negative and irradiated, with an additional option to describe other requirements.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},203516,1788561617,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":81},549768702563,"https://ap-avatar.wpscdn.com/avatar/8000c4aa63b76e948b?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786536092046926083","New York Blood Center  \nTesting Request form-Platelet Antibody Screen Cross-Matched Platelets-fillable NY-Fillable Form-rel , NY-FRM-0451, Rev: 06 Effective: 27 Aug 2025  \nTesting Request  \nPlatelet Antibody Screen / Cross-Matched Platelets  \n\n| \u003Cbr>\u003Cbr>Form and   Specimen\u003Cbr>Instructions\u003Cbr>|  | Fax completed form to 718-752-4756 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  |  | Label all specimens clearly-Last name, first name, date of birth, date drawn |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  | 1 | Specimen requirements:\u003Cbr>(2) tubes Whole Blood (no gel) or 4 mL serum/plasma.\u003Cbr>Acceptable anti-coagulants are EDTA, ACD, CPD or CPDA-1. Samples should be transported with ICE or cold packs and MUST be less than 48 hours old when received for testing. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  | 2 | For specimen pick-up: Contact Client Services Department at:\u003Cbr>855-552-5663 or 718-707-3771 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  | 3 | Send specimens with a copy of this form to:\u003Cbr>Rye QC/Reference Laboratory, 601 Midland Ave, Rye, New York 10580 Main Phone \\#: 718-752-4622 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| \u003Cbr>\u003Cbr> Hospital Information\u003Cbr>\u003Cbr>|  | Hospital name: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date:\u003Cbr>|  |  |  |  |\n|  |  | Street Address: |  |  |  |  |  | City: |  |  |  |  | State: |  |  |  |  | Zip:\u003Cbr>|  |  |  |\n|  |  | Contact Person name: |  |  |  |  |  | Blood bank phone: |  |  |  |  | Fax number:\u003Cbr>|  |  |  |  |  |  |  |  |\n|  |  | Last name: |  |  |  | First name: |  |  |  | DOB: |  |  | MRN:\u003Cbr>|  |  |  |  |  |  |  |  |\n| | Patient\u003Cbr>Information | Gender |  |  | Blood Type |  | CMV Status |  |  |  |  | Current Platelet Count |  |  |  |  |  |  |  |  |  |\n|  |  | ☐ Male |  |  | ABO: |  | ☐ | Negative |  |  |  | Number: |  |  |  |  |  |  |  |  |  |\n|  |  | ☐ Female |  |  | Rh: |  | ☐ | Positive |  |  |  | Date: |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  | ☐ | Unknown |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  | Diagnosis: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Sample Info |  | Collection Date of Sample sent- or ☐ No Sample sent |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| \u003Cbr> Request  Details\u003Cbr>|  | Requested Test |  |  |  |  | Cross Matched Platelet Request\u003Cbr>☐ Non-Type Specific acceptable\u003Cbr>If not acceptable, complete next\u003Cbr>columns \u003Cbr>|  |  |  |  |  |  |  |  | Restrict to types: |  |  |  |  |  |\n|  |  | ☐ Platelet Antibody Screen |  |  |  |  |  |  |  |  |  |  |  |  |  | ☐ A |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ☐ AB |  |  |  | ☐ | Rh+ |\n|  |  | ☐ | Additional Sample for Future Testing |  |  |  |  |  |  |  |  |  |  |  |  | ☐ B |  |  |  | ☐ | Rh- |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ☐ O |  |  |  |  |  |\n| | Product\u003Cbr>Delivery | ☐ STAT |  |  | Special\u003Cbr>Requirements |  | ☐ CMV Negative |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  | ☐ ASAP |  |  |  |  | ☐ Irradiated |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  | ☐ ROUTINE |  |  |  |  | ☐ Other (describe): |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Date(s) of Transfusion is required to supply product with useable expiration date: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Enter each date of transfusion: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Amount requested per transfusion: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\n\n| QC Reference Use ONLY\u003Cbr>Specimen Details | Received date/time: | Received by (name) : | Condition |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n|  |  |  | ☐ | Acceptable | ☐ | Unacceptable |\n|  | Comments: |  |  |  |  |  |","cbCaikfqMJhkcSmP","https://ap.wps.com/l/cbCaikfqMJhkcSmP","pdf",886670,"English","# Testing Request\n## Platelet Antibody Screen / Cross-Matched Platelets\n## Form and Specimen Instructions\n## Hospital Information\n## Patient Information\n## Request Details\n## Product Delivery\n## QC Reference Use Only","[{\"question\":\"What specimen types and timing are accepted for the platelet antibody screen and cross-matched platelets test?\",\"answer\":\"Acceptable specimens are two tubes of whole blood (no gel) or 4 mL serum/plasma. Samples must be transported cold and must be less than 48 hours old when received for testing.\"},{\"question\":\"How should specimens be labeled and sent to the laboratory?\",\"answer\":\"Label all specimens clearly with last name, first name, date of birth, and date drawn. Fax the completed form, then send specimens with a copy of the form to the Rye QC/Reference Laboratory address provided.\"},{\"question\":\"Which delivery options and special requirements can be selected for the requested platelet product?\",\"answer\":\"Delivery urgency options include STAT, ASAP, and ROUTINE. Special requirements include CMV-negative and irradiated, with an additional option to describe other requirements.\"}]","NY-FRM-0451 - Testing Request Form - Platelet Antibody Screen / Cross-Matched Platelets - Instructions | PDF"]