BLOOD WITHDRAWAL NOTICES

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THIS PAGE PROVIDES TWO EXAMPLE TYPICAL BLOOD RECALL AND/OR WITHDRAWAL FORMS AND INFORMATION ON THE FORM AND ITS USES.

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Following are two examples of Blood or Blood product  recall or withdrawal notices.

Typical General Blood Withdrawal Notice

The    blood processor    has notified us that certain lots of    blood product    were prepared from blood donated by individuals who were subsequently diagnosed with  blood impurity or inclusion delineated   .

According to our records you,    Your Name    has received    blood product    before it was recalled by the    blood processor  .

To date we have seen no evidence that your child will develop    named disease   . Therefore, there is little reason for concern. But we also know that the more informed you are about this situation, the more re-assured you will feel.

We hope that the enclosed information will answer many of your questions. If not, please call our transfusion information telephone line at     telephone number  .


Typical Blood Withdrawal Notice Received by a Parent for a Child

Dear    Parent - Child's Name  ,

Our blood bank records for    date    indicate that your child received blood or blood products that may have a potential contaminant.    blood processor    has advised that this particular batch of blood or blood products may contain blood from a donor who has died of    named disease    . This batch of blood or blood products has been withdrawn from the blood supply by    blood processor  .

  Named disease    is a disease that affects an estimated    number of humans    per year.  There have been cases of transmission of    named disease    from one person to another through transplant tissue and growth hormone obtained from cadavers. In view of the theoretical possibility of transmitting the disease through blood or blood products, the United States Food and Drug Administration and the Canadian Red Cross have advised that potential recipients be informed.

1.    named disease information one   .

2.    named disease information two   .

3.    named disease information three   .

We are concerned about maintaining the safety of the blood supply in   Country  .  As the information in this notification indicates, there is almost no real risk of blood recipients contracting the disease.  However, the best way to insure safety is through cautious surveillance.  We would be grateful if you would take the time to read the fact sheet on    named disease    that is enclosed.  If you have any questions or concerns about symptoms, please contact your family physician or the specialist who treated you as an in-patient or out-patient of the hospital.

Our records show the two doctors listed below. The doctor, who was involved with your transfusion of blood or blood products, has been notified by us.

Dr.   named doctor one 

Dr.   named doctor two 

 

Sincerely yours,

  supervising physician   , M. D.

 


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   last updated 11/10/2004   bloodbook.com