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Lecia Guill

30 minutes to return issued product to BB?

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Historically transfusion services have required that blood products be returned to the Blood Bank within 30 minutes if not transfused and if not placed in an alternate storage container. Other than preventing the product from being discarded due to improper storage, is there any other reason that this has become a standard of practice (e.g., accrediting agency requirement)?

We are having some difficulty with nursing compliance at our facility. Pathology's position is that if the product is transfused in 4 hours, what is the harm?

What are your thoughts? Do you have any resources to back your opinion? Thanks in advance!

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Lecia -

It's not that the donor blood must be destroyed if the transfusion (or proper storage) does not take place within 30 minutes..........

The standard is referring to donor blood that is returned to Blood Bank. If donor blood is out of the proper storage temp (ie: typically for 20 or 30 minutes) it cannot be returned to Blood Bank to be reissued (and therefore should be destroyed.)

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what do you do with plasma? if thawed and then directly issued it is warm at issue. do you discard it if returned after 30 mins. of issue?

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what do you do with plasma? if thawed and then directly issued it is warm at issue. do you discard it if returned after 30 mins. of issue?

Suhu -

That gets kind of tricky, doesn't it? Since the thawed plasma is probably warmer than room temp at the time we issue it (ie: we routinely issue it immediately after it is thawed), does it really matter if it stayed at room temp for an hour before it is returned to Blood Bank?

In most situations I would probably accept the plasma back and refrigerate it (as Malcolm explained) and document my approval of the deviation from the 30 minute rule. However, if the thawed plasma was out of Blood Bank for several hours or any other circumstances that made me feel uncomfortable, I would probably destroy the plasma (and not have to worry about justifying a deviation or a big financial loss.)

Sounds rather wishy-washy, but sometimes management just has to the call when things aren't black & white. (That's why we all get paid those BIG BUCKS, right?!!!)

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Just a thought -

I was under the impression that the temperature of the unit was more important to the FDA than anything else. We started doing Temp checks on returned units years ago and will not accept a unit back for storage if it has exceeded 10C. (Use Hemptemps II from Biosynergy, Inc). We immediately place the indicator on the unit and place in the frig. We set a timer for 5 min and check to see if the unit is within temp range - if so, we accept back for storage. If not - the floor is told they can still transfuse if they can get the problem fixed and get the unit infused within the original 4 hour transfusion limit. If they can not transfuse in the original 4 hours, we destroy the unit. We lose more units this way, but the small pheresied units (usually 280 ml) will not hold a temp <10C for anyways near 30 min. Also, if it comes back cold after being out 30 mins, do you assume it has been stuck in a floor refrigerator? What do you do then?

We have the same problem with thawed FFP - it is warm when you issue it - what to do? We have been taking it back for use within 24 hours by the original recipient only, don't really know if that makes sense or not.

any feedback appreciated :confused:

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You are doing pretty much what we do. We have the nursing staff from the floors pretty well trained and they bring back units pronto. ER...forget it! OR...sometimes. Our waste rate has gone down because we have policed this issue strongly. Violators of our policy get a hospital occurence report written which includes dollars lost, the first viewer of which is one of the hospital vice-presidents. Tends to be quite effective.

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To me there is a discrepancy between AABB Standards and the Technical Manual. Standards state that red cells should be stored (maintained) between 1-6C. Out of refrigeration, a unit of red cells will reach >6C generally within 15 minutes. I think the 30 minute guideline should be eliminated.

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Red cells shoud be kept between 1 - 6C in a monitored refrigerator during storage. During transportation, red cells are allowed to kept between 1 - 10C. Over 30 mins without refigerate, temperature rises over 10C.

CK Cheng, MSc, SBB(ASCP), CQA(ASQ)

July 8, 2009

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Our understanding from an FDA standpoint is that once the blood is within the transfusion service control it is being stored and therefore must be maintained at 1-6C. We were told that the 1-10C was strictly for transport between facilities.

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