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May 2024 Challenge

Confused after reading the 17th ED of AABB Technical Manual

mcclanmd

By mcclanmd
in Transfusion Services

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mcclanmd Rookie

mcclanmd

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Hello all! I need your guidance, please. My current policy states that blood components may be returned to the Blood Bank within 30 minutes of issue as long as certain requirements are met. I've been reading the 17th Edition of the AABB Technical Manual, and I'm confused. According to Chapter 9, "if individual unit temperature indicators or reading devices are not being used, or if the blood components are not being returned in validated transport containers, acceptable time frames for returning blood components to inventory should be validated by individual facilities". We don't use temperature indicators on each unit of blood, and we simply use plastic bags to transport the unit to the floor. To my knowledge, the prior Blood Bank Supervisor at my facility did not perform any validation regarding this 30-minute time frame. I think she simply used the recommended time frame in the prior editions of the Technical Manual as a reference. How did you validate the time frame for returning blood components to inventory?

Also, one additional question...Do any of you define a maximum number of units that staff can enter into inventory at one time? I have limits on the maximum number of units that can be stored in the OR cooler, but I do not define how many units a tech can enter into inventory at any one time. Of course, we're a rural hospital. Our routine blood order usually does not exceed 25 units. When I enter units into inventory, I never process more than 10 units at a time. However, this has not been validated and is not defined in my current policy. If I'm reading correctly, Chapter 9 seems to suggest that I need to define this in my policy.

I appreciate any input you can provide! I have lots to learn. Thanks in advance.

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Liz Mentor

Liz

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Q: How did you validate the time frame for returning blood components to inventory?

A: We asked the Medical Engineers' help. They took units and let them stand outside (room temperature) while inserting their thin wire probe to continuously register the temperatures. We documented everything and the temperature required for each unit to reach 6C and 10C. This allowed us to know the time frame in which our units remained safe. We also gained this information for the irradiation process, depending on your type of Irradiator: if you use Cesium the time required for irradiation increases as the years go by. If that time becomes long you worry about the RBCs. We validated the time this way, and I advise it.

Q2: Do any of you define a maximum number of units that staff can enter into inventory at one time?

No, we do not have such a policy. Is it a CAP requirement as well as an AABB standard? Is the concern a mix-up?

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Auntie-D Mentor

Auntie-D

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...but the 30 minutes takes into account multiple removals from the fridge which is why we sould adhere to it, regardless of whether the unit reaches 10 or not (8oC in the UK). There is even talk here of extending the regulations so that the unit is only allowed to be out of the friedge for 30 minutes in total, regardsless of how many times is has had to be crossmatched.

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Malcolm Needs Grand Master

Malcolm Needs ☆

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...but the 30 minutes takes into account multiple removals from the fridge which is why we sould adhere to it, regardless of whether the unit reaches 10 or not (8oC in the UK). There is even talk here of extending the regulations so that the unit is only allowed to be out of the friedge for 30 minutes in total, regardsless of how many times is has had to be crossmatched.

There is also a good deal of work going on to see whether or not there is actually any deterioration if the red cells are kept out at room temperature for much, much longer than 30 minutes, and, so far, the results are showing that there isn't (although there is a LOT more work to be done). I heard this in a lecture at the recent IBMS Congress, by one of the people doing the work.

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Liz Mentor

Liz

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So Liz......what did you validation so? How long could one of your units be at RT before it exceeded 10oC? Were your unit packed cells or ADSOL units.

By the way, the 30 minute time limit was established with glass bottles and whole blood.

:abduction

I remember we had good results.

I looked them up: Blood Bag temperature 20 min after withdrawal from the refrigerator was measured by two methods:

- Surface temperature using Infrared thermometer: 7.8 ºC

- Blood temperature using a calibrated thermistor and inserted in the bag (in contact with blood): 5.6 ºC

So, it is also important how you measure the temperature of the blood.

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SMILLER Mentor

SMILLER

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Awesome! Once they get this validated, we won't have to worry so much about our darn freezers and refrigerators breaking down any more! Its such a bother to have to transfer product from one to another when this happens! In the future we'll be able to just throw them in a cupboard!

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