retention of used blood bags

[RR1]

Thanks everyone, explains a few differences. In the UK our lines are not pre-segmented ,although a few (many??) years ago some we received were , depending on which blood transfusion centre they were processed in.

It would be more easily acheivable in the UK if these lines were segmented for us, although I can also remember the segment 'bundles' being completely pulled from the unit and occassionally we would have to match up with the correct bag.

[Malcolm Needs ☆]

Thanks everyone, explains a few differences. In the UK our lines are not pre-segmented ,although a few (many??) years ago some we received were , depending on which blood transfusion centre they were processed in.

It would be more easily acheivable in the UK if these lines were segmented for us, although I can also remember the segment 'bundles' being completely pulled from the unit and occassionally we would have to match up with the correct bag.

Did you ever try to remove them GENTLY Rashmi?????????

It under G in the usual dictionaries!!!!!!!!!!!!!!!!!!!

:peaceman::peaceman:

[RR1]

Did you ever try to remove them GENTLY Rashmi?????????

It under G in the usual dictionaries!!!!!!!!!!!!!!!!!!!

:peaceman::peaceman:

No- they fell off on receipt!!. Anyway, gently isn't in my vocabulary at the moment!

[Malcolm Needs ☆]

Knowing what I do, I cn fully understand that.

[NedB]

According to CAP and AABB we must keep segments seven days post-transfusion. Since we crossmatch for up to three days prior to transfusion, we only need to keep segments a total of ten days, usually. To take into account extending crossmatches (to a maximum of seven days from date of specimen, we devised a protocol of tagging the segment used for crossmatch with the unit number in a plastic 12x75 mm tube and storing this in a dated rack which we discard after two weeks. I don't see the need for repeating crossmatches when investigating delayed transfusion reactions - if an antibody reacted with red cell antigens, you would find the aantibody on elution. If the antibody reacted so stronly that no red cells survived to be coated, the symptoms would show immediately, not delayed. Services who do donor testing probably need to set up a longer retention, but the original pilot samples would be best for this.

[Eoin]

urprised at the no repeat crossmatch NedB. Surely this is still a transfusion reaction and should be treated as same, testing with pre and post samples - also nice to not see Ab in pre Tx samples and pos in post Tx patient sample. Gives staff confidence.

What do others feel?

Cheers, Eoin

[Malcolm Needs ☆]

urprised at the no repeat crossmatch NedB. Surely this is still a transfusion reaction and should be treated as same, testing with pre and post samples - also nice to not see Ab in pre Tx samples and pos in post Tx patient sample. Gives staff confidence.

What do others feel?

Cheers, Eoin

I agree entirely Eoin.

In any case, it could be that an extra, so far unidentified antibody has caused the problem.

Not all techniques and technologies detect all antibodies.

[Catherine Almond]

Hi Pluto

We stopped retaining them last year. We were told that they were too much of an infection risk (CPA) what with transporting them back to the lab from the ward and then storing them. Our risk assessment was (like yours) 'we very rarely have to use them again and if we did, do we ever audit the fact that every single one is returned?' NO! We haven't missed them I have to say

Catherine

[kate murphy]

We do what's described earlier - upon receipt, place one segment with the unit # label wrapped around it, in a plastic zip-lok with a date of 42 + 7 days for discarding. We do not get used blood bags back, as it is biological waste at that point.

I do have a comment for NedB about not re-crossmatching for a delayed transfusion workup. One of the purposes of the reaction workup is to check for technical errors - that you crossmatched the right unit for the right patient. Re-doing ABO/Rh and the crossmatch in select instances checks for technical/clerical error in the BB.

Also, there have been cases of weak antibodies not picked up in pre-transfusion testing, but seen post-transfusion. An eluate will not tell the whole story, you need to see what's in the plasma/serum too. Some patients that recieve more than a few units, may have a neg DAT due to dilution, and a neg eluate. Wouldn't you be more reassured if the unit given was still compatible with the post sample? If it's incompatible, wouldn't you investigate more? Like checking your systems/processes, your reagent QC, the training/competency of your staff? And maybe make some recommendations on patient treatment...

Just my thoughts.....

[PammyDQ]

We wrap a unit number around a segment and throw it in a bag that is labeled with receive dates. if we need a segment, we sit down and sort through the bag. We don't often go back to the bag , maybe a couple of times per year. It works for us.

SAME WITH US...we have 3 bins for 3 months. When the new month comes up, we dump the oldest bin.

[carolyn swickard]

We take 2 segments off as we issue the units, place them in a cup labeled for each day and have a rack that stores 14 days of the cups. Each segment pair is wrapped with a DIN number from the back of the unit (or handwritten on tape if all the DIN tags are gone). We very seldom have to go back for the segments, but they have been easy to find (we issue around 15-20 units a day) when needed. We do not keep segments for plasma products, only RBCs and have called and had the RN or the OR do it for us on the few times we have forgotten to get the segments. Since the cup is on the issue desk itself, that helps to remind us to get the segments. We haven't had the actual units themselves returned in years - yuk!! One of the segment sealers would probably do a nice job making usable segments for those facilities that do not get them pre-segmented - expensive, but definitely worth the cleaner procedure.

[Mabel Adams]

My current place we are similar to others--pull and label segments on receipt of units. At my prior place, we pulled segs as we xmd units and kept them attached to the patient sample they were xmd against. This gives a way to trouble-shoot a problem if the tech does not do the sero testing on the right segment for the unit he sets up on the patient. I always worry about people mixing up units from a batch of antigen-typed units.

We had a transfusion reaction once at the prior workplace that we used the segment to discover that a unit negative for the antigens to the lady's 4 known antibodies was actually incompatible due to a previously undiscovered antibody to a low-freqency antigen (Cw I think). I guess the tech doing the tube AHG xm was too busy flirting with the morning tech at the end of his night shift while he was doing the testing and didn't see that it was 1-2+ incompatible. I was there, so I know he was flirting. I repeated the xm from the retained segment attached to the pt. sample and found it incompatible in tube AHG even without adding LISS. Maybe he shook too hard. Due to that and other problems, I believe he has left the field. Anyway, in that case a segment on receipt would have worked. But what if you have staff as problematic as he was in this tech shortage and you can't be sure what they will do! Obviously best to solve the personnel problem, but it is worth considering what you have to do to trouble-shoot errors that could be made by your staff.

[jcdayaz]

We tried pulling of at time of issue but we had too many people forget to pull them at time of issue (especially in stressful situations or off shifts). We currently pull them when the units come in and stick a unit number on each one. We put them in a zip lock bag. The bag is then labeled with the date the unit was received and is dated for discard in 42 days (longest possible out date of units).

Same here. We pull two segments off the units at time of receipt into the Blood Bank. One we use to retype the unit, the other is saved in a bucket with a unit number sticker affixed. Yeah, it can get very cumbersome to search through a week's worth of segments...but it is rare that we have to do it.

We have @ 8 buckets for segments...we rotate them every Monday. It works for us!

[MAGNUM]

It appears that we are following suit here with a lot of the members out there. When we issue a unit of blood, we pull a segment from the unit and include it in the tube with the original segment used for testing. I have 4 big racks that are used for this purpose, when one is full, I discard the oldest rack in the refer (usually about 2-3 weeks old), and start refilling with the new segments.

[MAGNUM]

Also we do not require the used bags be returned to the blood bank, unless of course there is a reaction going on at the time.

[Frances Haas]

We do the same as clmergen. The bags of segments are kept for 6 weeks, then thrown away. We have to look once a year at the most. We buy our blood products from UBS, so we can also request a segment from them.