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For open heart surgery our perfusion team washes the red cells in the OR (faster than we can) and uses those with a small amount of FFP (for babies usually < 1 year especially those < 4kg). Our policy is to provide 1 fresh, <6 day old, irradiated (<24 hours) AS3, CPD, CPDA-1 or CP2D packed red cell for post CPB but we give then two <= 10 day old unit (irradiated, AS3, CPD, CPDA-1 or CP2D) and mark them "To Be Washed" for priming the CPB. For non-pump cardiac surgeries we wash if the patient is <4kg. I would love to get away from washing RBCs for surgeries (we also wash for major open belly procedures on <4kg infants) but over 20 years ago a patient died because of a K+ overload from a RBC that was irradiated 3 days prior to surgery even thought the unit was still <6 days old. Now I can't even get our Transfusion Committee to even discuss the topic. Guess I just wait until more surgeons retire.

And now you are beginning to achieve enlightenment.

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record. Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

We require a signature from the ordering provider if emergency release is requested whether the product was actually transfused or not. We keep the signed form as part of our documentation for the event.