ACCEPTABLE TEMP FOR TRANSPORTED PLATELETS/CRYO

[jalomahe]

What does everyone use for acceptable temperature of returned platelets and cryoprecipitate?

AABB Stds state storage is 20-24C and Transport is "As close as possible to 20-24C"

We have had platelets that when they were received from the supplier had been riding around in the back of the courier's car for awhile and felt warm to the touch. Another time in the winter, they were cold to the touch. So how warm is too warm, how cool is too cold?

Similarly we've had cryoprecipitate issued during an MTP that was returned in the cooler with the RBCs, they were still in the padded transport bag they were issued in but they were cool to the touch so again, how cool is too cold?

Thanks for your input.

[Teristella]

What do you mean by cool to the touch? You should be temping the products, if you cannot show they were at an acceptable temperature, you shouldn't be accepting them back into inventory... This is part of why we have a time limit and a temperature requirement here. Of course even if the units have been out only 10 minutes, if they are too warm we discard them, but also if they are in temp (not issued to a refrigerator or cooler) and it's been longer than the acceptable time limit, they are discarded because we can't show what happened the unit during that time frame.

We temp our platelets while the courier is still here because we have had issues in the past with them being out of temp. If they aren't within the proper range they send us new ones.

Edit to add: We use the transport temperature for our acceptable ranges.

 

Edited September 21, 2016 by Teristella

[pinktoptube]

We use 20-24C, once units are returned we take the temp.

[Sandy L]

Our supplier uses room temperature gel packs that are stored in a controlled 20-24C chamber.  Platelets are packed in an insulated carton with the room temperature gel packs to assure that platelets do not get to cold or too warm during transport.  It sounds like your supplier should address how they are shipping platelets.

[BankerGirl]

15 hours ago, Sandy L said:

Our supplier uses room temperature gel packs that are stored in a controlled 20-24C chamber.  Platelets are packed in an insulated carton with the room temperature gel packs to assure that platelets do not get to cold or too warm during transport.  It sounds like your supplier should address how they are shipping platelets.

Ours are transported this way as well, however we have still had rare instances where they were not within the 20-24 degree range when they arrived during extreme weather conditions.  When this happens we call the supplier and they decide if they are acceptable or will be replaced.

I believe that the original question was for units issued for transfusion but returned unused.  For this scenario we take the temps, examine the product, and decide from there.  

Edited September 22, 2016 by BankerGirl
added a step

[jalomahe]

The question was about the ambiguity of the AABB published temperature requirements for transport.

AABB Stds state storage is 20-24C and Transport  "As close as possible to 20-24C"

What is considered to be "as close to possible"? If it is received from the supplier and the temperature is 18C is that okay? What about 16C? or on the upper side of the range....Is 26C okay or how about 28C?

How do I tell techs what "as close as possible" really is for transported platelets?

 

[goodchild]

There's no requirement to measure the temperature when you receive blood products from the supplier, only to confirm that the products were shipped appropriately.

[jalomahe]

Devil's advocate: So if the product was shipped appropriately however you suspect that there was possibly a temperature failure anyway (for whatever reason) ... you wouldn't check the temperature?

Our blood components are transported from the supplier by an independent courier service. There have been rare occasions where we have received platelets that although they were packed appropriately they "felt" cooler or warmer than we would have expected (usually during our extreme weather extremes). SO wouldn't it be prudent to check the temperature to make sure they are okay? BUT if we do take the temperature .... what qualifies as "As close as possible to 20-24"?

Any AABB inspectors out there?

[AMcCord]

Our blood supplier recommended years ago that we check temps upon receipt. We receive product via an independent courier service and we experience extremes in temperatures - hot and cold - so there are always a few times a year that we receive units that are not acceptable. Our supplier uses a spirit thermometer so they are rounding their temps to the next closest number, which I guess fits what the AABB is saying maybe.

We use a digital thermometer to take temps so we've come up with a rule after talking with our supplier's medical director. For platelets our rule of thumb is that if the product is over 24 C it is not acceptable due to increased risk of bacterial growth. If the product is under 20 C but warmer than 19ish C and the platelets pass the shimmer/swirl test, the unit can be infused with the approval of the blood bank medical director. If the unit is 18ish and the patient needs them before we can get resupplied (which can take 3-4 hours in urgent circumstances), we do the shimmer test and if they pass will consider transfusion based on the patient's condition. We let the cold platelets warm up 30 minutes or so before we check for shimmer. We do report the outlier temps so that shipping conditions can be addressed with the courier service.  

On the topic of cold platelets, there are studies regarding utilization of cold stored platelets for trauma patients. So using platelets that are a little below 20 C for a short period of time is not a crazy concept. The decision to use them should take into consideration some possible loss of platelet function, time delay to wait for restock and patient condition. This I defer to my medical director.

 

[Marianne]

It is  "Say what you do and do what your say".  You must define in your SOP what you will accept and then monitor that, as well as have a plan for what you will do if the products are not within your definition.  Make sure you make clear in your SOPs what is "storage" and what you consider "transport" as well.

Might be good to ask what others on this website consider an acceptable range.  Is it +/- 1 degree, or 2 degrees etc.  See if there is a consensus and then use that as best practice.