HEMATOLOGY LAB THERAPY PLAN		version 2/18/2026		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	2 times a week	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Type and screen				
		Routine, Normal, Clinic Collect		
	☐	CBC with platelet and differential	2 times a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	2 times a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	LDH	2 times a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Uric acid level	2 times a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Magnesium level	2 times a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Partial thromboplastin time, activated	2 times a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Prothrombin time with INR	2 times a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Fibrinogen	2 times a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		
	☐	Phosphorus level	2 times a week	S	Until discont'd	
		Routine, Normal, Clinic Collect		

Transfusion Product 	

	
	Interval	Defer Until	Duration	
	☐	Prepare RBC	2 times a week	S	Until discont'd	
		Routine, Blood
	Transfuse PRBC's for Hemoglobin less than 7 mg/dL.		
	☐	Prepare platelet pheresis	2 times a week	S	Until discont'd	
		Routine, Blood
	Single donor leukoreduced, irradiated platelets for counts less than 20,000/cc.		

Nursing Transfusion Orders 	

	
	Interval	Defer Until	Duration	
	☐	Obtain consent	2 times a week	S	Until discont'd	
		The "Benefits versus Risks" of Blood and Blood Product transfusion have been discussed with the patient.
	Has consent been obtained? Yes		
	☐	Transfuse RBC	2 times a week	S	Until discont'd	
		Transfuse  PRBC's for Hemoglobin less than 7 mg/dL.		
	☐	Transfuse platelet pheresis	2 times a week	S	Until discont'd	
		Single donor leukoreduced, irradiated platelets for counts less than 20,000/cc.		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	2 times a week	S	Until discont'd	
		650 mg, oral, once, Starting when released
	Administer 30 minutes prior to transfusion product.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) injection 12.5 mg	2 times a week	S	Until discont'd	
		12.5 mg, intravenous, PRN, anaphylaxis/allergic reaction, Starting when released, Until Discontinued
	Administer 30 minutes prior to transfusion product		
	☐	famotidine (PEPCID) tablet 20 mg	Every visit	S	Until discont'd	
		20 mg, oral, once, Starting when released
	Administer 30 minutes prior to transfusion product
	Indication(s) for H2 Receptor Antagonist (H2RA) Therapy: Hypersensitivity Prophylaxis		
	☐	famotidine (PEPCID) injection 20 mg	Every visit	S	Until discont'd	
		20 mg, intravenous, once, Starting when released
	Administer 30 minutes prior to transfusion producta
	Indication(s) for H2 Receptor Antagonist (H2RA) Therapy: Hypersensitivity Prophylaxis		
	☐	fexofenadine (ALLEGRA) tablet 180 mg	Every visit	S	Until discont'd	
		180 mg, oral, once, Starting when released
	Administer 30 minutes prior to transfusion product