Fillable Printable 57.303 Toi 8 1
Fillable Printable 57.303 Toi 8 1
57.303 Toi 8 1
NHSN Biovigilance Component
Tables of Instruction v2.3
www.cdc.gov/nhsn
Page 1 of 6
January 2017
Hemovigilance Module Monthly Reporting Denominators (CDC 57.303)
Note: All units not transfused and removed from inventory should be included in total discards
(e.g., total number of discards includes outdated/expired units, improperly stored units, and
units discarded for any other reason).
Data Field Instructions for Form Completion
Facility ID# The NHSN-assigned Facility ID number will be auto entered by the
system.
Month Required. Indicate the month for the form being entered.
Year Required. Indicate the year for the form being entered.
Table 1 Products Units Transfused, Aliquots Transfused, and Total Discards
Whole
Blood
Total Required. Enter the total number of units transfused, aliquots
transfused, and discards of whole blood during the month. Note: Do
not include the units from which aliquots were made in unit count.
Whole
blood
derived
Red blood
cells
Total Required. Enter the total number of units transfused, aliquots
transfused, and discards of whole blood derived (WBD) red blood
cells (RBCs) during the month that were not irradiated or leukocyte
reduced, irradiated only, leukocyte reduced only, and irradiated and
leukocyte reduced. Note: Do not include the units from which
aliquots were made in unit count.
Not irradiated
or leukocyte
reduced
Required. Enter the number of units transfused, aliquots
transfused, and discarded WBD RBCs during the month that were
not irradiated or leukocyte reduced. Note: Do not include the units
from which aliquots were made in unit count.
Irradiated Required. Enter the number of units transfused, aliquots
transfused, and discarded WBD RBCs during the month that were
irradiated only. Note: Do not include the units from which aliquots
were made in unit count.
Leukocyte
reduced
Required. Enter the number of units transfused, aliquots
transfused, and discarded WBD RBCs during the month that were
leukocyte reduced only. Note: Do not include the units from which
aliquots were made in unit count.
Irradiated and
leukocyte
reduced
Required. Enter the number of units transfused, aliquots
transfused, and discarded WBD RBCs during the month that were
both irradiated and leukocyte reduced. Note: Do not include the
units from which aliquots were made in unit count.
Apheresis
Red blood
cells
Total Required. Enter the total number of units transfused aliquots
transfused, and discarded apheresis RBCs transfused during the
month that were not irradiated or leukocyte reduced, irradiated only,
leukocyte reduced only, and irradiated and leukocyte reduced. Note:
Do not include the units from which aliquots were made in unit
count.
NHSN Biovigilance Component
Tables of Instruction v2.3
www.cdc.gov/nhsn
Page 2 of 6
January 2017
Data Field Instructions for Form Completion
Not irradiated
or leukocyte
reduced
Required. Enter the number of units transfused, aliquots transfused
and discarded apheresis RBCs during the month that were not
irradiated or leukocyte reduced. Note: Do not include the units from
which aliquots were made in unit count.
Irradiated Required. Enter the number of units transfused, aliquots
transfused, and discarded apheresis RBCs during the month that
were irradiated only. Note: Do not include the units from which
aliquots were made in unit count.
Leukocyte
reduced
Required. Enter the number of units transfused, aliquots
transfused, and discarded apheresis RBCs during the month that
were leukocyte reduced only. Note: Do not include the units from
which aliquots were made in unit count.
Irradiated and
leukocyte
reduced
Required. Enter the number of units transfused, aliquots transfused
and discarded apheresis RBCs during the month that were both
irradiated and leukocyte reduced. Note: Do not include the units
from which aliquots were made in unit count.
Whole
blood
derived
Platelets
Total Required. Enter the total number of units transfused and discarded
WBD platelets during the month that were not irradiated or
leukocyte reduced, irradiated only, leukocyte reduced only, and
irradiated and leukocyte reduced. Note: Report the number of
individual concentrates pooled into each therapeutic dose. For
example, if 6 donor concentrates were pooled to create one WBD
platelet unit, count 6 unit for denominator reporting.
Not irradiated
or leukocyte
reduced
Required. Enter the number of units transfused and discarded
WBD platelets during the month that were not irradiated or
leukocyte reduced.
Irradiated Required. Enter the number of units transfused and discarded
WBD platelets during the month that were irradiated only.
Leukocyte
reduced
Required. Enter the number of units transfused and discarded
WBD platelets during the month that were leukocyte reduced only.
Irradiated and
leukocyte
reduced
Required. Enter the number of units transfused and discarded
WBD platelets during the month that were both irradiated and
leukocyte reduced.
Apheresis
Platelets
Total Required. Enter the total number of units transfused, aliquots
transfused, and discarded apheresis platelets during the month that
were not irradiated or leukocyte reduced, irradiated only, leukocyte
reduced only, and irradiated and leukocyte reduced. Note: Do not
include the units from which aliquots were made in unit count.
Not irradiated
or leukocyte
reduced
Required. Enter the number of units transfused, aliquots
transfused, and discarded apheresis platelets during the month that
were not irradiated or leukocyte reduced. Note: Do not include the
units from which aliquots were made in unit count.
Irradiated Required. Enter the number of units transfused, aliquots
transfused, and discarded apheresis platelets during the month that
NHSN Biovigilance Component
Tables of Instruction v2.3
www.cdc.gov/nhsn
Page 3 of 6
January 2017
Data Field Instructions for Form Completion
were irradiated only. Note: Do not include the units from which
aliquots were made in unit count.
Leukocyte
reduced
Required. Enter the number of units transfused, aliquots
transfused, and discarded apheresis platelets during the month that
were leukocyte reduced only. Note: Do not include the units from
which aliquots were made in unit count.
Irradiated and
leukocyte
reduced
Required. Enter the number of units transfused, aliquots
transfused, and discarded apheresis platelets during the month that
were both irradiated and leukocyte reduced. Note: Do not include
the units from which aliquots were made in unit count.
Plasma
(all types)
Total whole
blood derived
Required. Enter the total number of units transfused, aliquots
transfused, and discarded WBD plasma (e.g., fresh frozen, thawed,
etc.) during the month. Note: Do not include the units from which
aliquots were made in unit count.
Total
apheresis
Required. Enter the total number of units transfused, aliquots
transfused, and discarded apheresis plasma (e.g., fresh frozen,
thawed, etc.) during the month. Note: Do not include the units from
which aliquots were made in unit count.
Cryoprecipitate Required. Enter the total number of units transfused and discarded
cryoprecipitate during the month. Note: Report the number of
individual concentrates pooled into each therapeutic dose. For
example, if 6 individual concentrates were pooled to create one
cryoprecipitate dose, count 6 units for denominator reporting.
Table 2 Products Units Transfused, Aliquots Transfused, and Total Discards
Does your facility transfuse
blood products treated with
pathogen reduction
technology?
Required. Select ‘YES’ if your facility transfused pathogen reduced
blood products. Select ‘NO’ if your facility did NOT transfuse
pathogen reduced blood products.
If yes, complete the
following table
Enter total number of pathogen reduced blood products transfused
by product type and collection method in the following table.
Whole
Blood
Derived
Red blood
cells
Total Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discards of WBD RBCs during the month
that were S-303-treated or riboflavin treated. Note: Do not include
the units from which aliquots were made in unit count.
S-303-treated Conditionally required. Enter the number of units transfused,
aliquots transfused, and discarded WBD RBCs treated with S-303
during the month. Note: Do not include the units from which aliquots
were made in unit count.
Riboflavin-
treated
Conditionally required. Enter the number of units transfused,
aliquots transfused, and discarded WBD RBCs treated with
riboflavin during the month. Note: Do not include the units from
which aliquots were made in unit count.
Apheresis
Derived
Total Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discards of apheresis RBCs during the
NHSN Biovigilance Component
Tables of Instruction v2.3
www.cdc.gov/nhsn
Page 4 of 6
January 2017
Data Field Instructions for Form Completion
Red Blood
Cells
month that were S-303-treated or riboflavin treated. Note: Do not
include the units from which aliquots were made in unit count.
S-303-treated Conditionally required. Enter the number of units transfused,
aliquots transfused, and discarded apheresis RBCs treated with S-
303 during the month. Note: Do not include the units from which
aliquots were made in unit count.
Riboflavin-
treated
Conditionally required. Enter the number of units transfused,
aliquots transfused, and discarded apheresis RBCs treated with
riboflavin during the month. Note: Do not include the units from
which aliquots were made in unit count.
Whole
Blood
Derived
Platelets
Total Conditionally required. Enter the total number of units transfused
and discarded WBD platelets during the month that were psoralen-
treated or riboflavin treated. Note: Report the number of individual
concentrates pooled into each therapeutic dose. For example, if 6
donor concentrates were pooled to create one WBD platelet unit,
count 6 unit for denominator reporting.
Psoralen-
treated
Conditionally required. Enter the total number of units transfused
and discarded WBD platelets treated with psoralen during the
month.
Riboflavin-
treated
Conditionally required. Enter the total number of units transfused
and discarded WBD platelets treated with riboflavin during the
month.
Apheresis
Platelets
Total Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discards of apheresis platelets during the
month that were psoralen-treated or riboflavin-treated. Note: Do not
include the units from which aliquots were made in unit count.
Psoralen-
treated
Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discarded apheresis platelets treated with
psoralen during the month. Note: Do not include the units from
which aliquots were made in unit count.
Riboflavin-
treated
Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discarded apheresis platelets treated with
riboflavin during the month. Note: Do not include the units from
which aliquots were made in unit count.
Whole
Blood
Derived
Plasma
(all types)
Total Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discarded WBD plasma (e.g., fresh frozen,
thawed, etc.) during the month that were psoralen-treated or
riboflavin-treated. Note: Do not include the units from which aliquots
were made in unit count.
Psoralen-
treated
Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discarded WBD plasma treated with
psoralen during the month. Note: Do not include the units from
which aliquots were made in unit count.
NHSN Biovigilance Component
Tables of Instruction v2.3
www.cdc.gov/nhsn
Page 5 of 6
January 2017
Data Field Instructions for Form Completion
Riboflavin-
treated
Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discarded WBD plasma treated with
riboflavin during the month. Note: Do not include the units from
which aliquots were made in unit count.
Apheresis
Plasma
(all types)
Total Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discarded apheresis plasma (e.g., fresh
frozen, thawed, etc.) during the month that were psoralen-treated or
riboflavin-treated. Note: Do not include the units from which aliquots
were made in unit count.
Psoralen-
treated
Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discarded apheresis plasma treated with
psoralen during the month. Note: Do not include the units from
which aliquots were made in unit count.
Riboflavin-
treated
Conditionally required. Enter the total number of units transfused,
aliquots transfused, and discarded apheresis plasma treated with
riboflavin during the month. Note: Do not include the units from
which aliquots were made in unit count.
Cryoprecipitate
TOTAL Conditionally required. Enter the total number of units transfused
and discarded cryoprecipitate during the month that were psoralen-
treated or riboflavin-treated. Note: Report the number of individual
concentrates pooled into each therapeutic dose. For example, if 6
individual concentrates were pooled to create one cryoprecipitate
dose, count 6 units for denominator reporting.
Psoralen-
treated
Conditionally required. Enter the total number of units transfused
and discarded cryoprecipitate treated with psoralen during the
month.
Riboflavin-
treated
Conditionally required. Enter the total number of units transfused
and discarded cryoprecipitate treated with riboflavin during the
month.
Table 3 Products Units Transfused, Aliquots Transfused, and Total Discards
Apheresis
Platelets
Psoralen-
treated
Automatically populated with the total number of psoralen-treated
apheresis platelets units transfused, aliquots transfused and
discarded entered in table 1.
Psoralen-
treated and in
Plasma
Conditionally required. Enter the total number of units transfused,
aliquots transfused and discarded apheresis platelets treated with
psoralen and in plasma during the month. Note: Do not include the
units from which aliquots were made in unit count.
Psoralen-
treated and in
platelet
additive
solution
Conditionally required. Enter the total number of units transfused,
aliquots transfused and discarded apheresis platelets treated with
psoralen and in platelet additive solution during the month. Note:
Do not include the units from which aliquots were made in unit
count.
NHSN Biovigilance Component
Tables of Instruction v2.3
www.cdc.gov/nhsn
Page 6 of 6
January 2017
Data Field Instructions for Form Completion
Riboflavin-
treated
Automatically populated with the total number of riboflavin-treated
apheresis platelets units transfused, aliquots transfused and
discarded entered in table 1.
Riboflavin-
treated and in
Plasma
Conditionally required. Enter the total number of units transfused,
aliquots transfused and discarded apheresis platelets treated with
riboflavin and in plasma during the month. These units must be in
plasma. Note: Do not include the units from which aliquots were
made in unit count.
Riboflavin-
treated and in
platelets
additive
solution
Conditionally required. Enter the total number of units transfused,
aliquots transfused and discarded apheresis platelets treated with
riboflavin and in platelet additive solution during the month.
These units must be in platelet additive solution. Note: Do not
include the units from which aliquots were made in unit count.
Patient samples collected
for type and screen or
crossmatch
Required. Enter the total number of patients blood samples
collected during the month for type and screen and/or crossmatch.
Total crossmatch
procedures
Required. Enter the total number of crossmatch procedures that
were actually performed by your facility.
Total patients transfused Optional. Enter the total number of patients transfused by your
facility.
Custom Fields Optional. Up to 50 custom fields may be added to this form for local
use. Custom data may be collected in an alphanumeric, numeric, or
date format.
