Stop transfusion if crossmatch expires after issue but before whole unit in?

[Mabel Adams]

If a unit is issued at, say, 2210 and the specimen (not the unit) will expire at MN, do they have to stop the transfusion at MN or is it okay to finish giving the unit if it isn't quite done by MN?  We use MN on day 3 as our crossmatch/specimen expiration (not exactly 72 hours) so theoretically a specimen even in normal circumstances could be over 90 hours hours old at the time of a transfusion if it was drawn very early in the morning.  I am convinced that medically it won't "turn into a pumpkin" at MN but what do you think inspectors would say?  Do you have a hard and fast policy for this or leave it up to judgment?  Is it okay to issue a unit on an expiring specimen as long as issuing occurs before the specimen expires, the infusion will start by the time the specimen expires, or only if the entire infusion can be completed by the time the specimen expires?

[pinktoptube]

As long as the unit is being transfused I don't see why you would stop the transfusion. The crossmatch at the time of dispense was still valid. I've never been questioned on this, maybe others have.

[Jane12]

In our system, valid specimen is required in order to issue an unit. But, on the nursing side it does not flag them if the specimen expired. They only need to be able to scan all the attributes of the unit issued and complete the clerical checks before starting the transfusion. We always issue blood even when the clot is expiring MN and later call & request them for a new XM specimen for future cross matches.

[SMILLER]

Agree with the above, and am pretty sure that that is all ok with regulators.  Note that a screen expiring is different from if the unit itself outdates--in that case the transfusion must stop.

Scott

[tcoyle]

Can you imagine what a nightmare of logistics it would be if we had to be concerned about that?   As long as you issued your product on that good specimen before it expired, you are fine.  We have the same practice.  Our day of draw is day 0 and then our specimens expire at midnight on day 3.  We could issue products on that specimen up to the minute before it expired. 

[John C. Staley]

Depends on the inspector!  Back in the day when I was inspecting, and yes it was called inspecting back then, I would not have even given it a second thought as long as the sample was acceptable and the unit was issued and hung prior to the expiration of the sample.  I have met those inspectors who would have been quite distraught over such a perceived infraction.  The best advice I can give you Mabel is, let your conscience and best judgement be your guide.  

[AMcCord]

We stop the infusion when the specimen expires. Units are issued with a date/time expiration for transfusion based on that. We've done it that way for years and it doesn't cause us many problems.

Back story - (distant) past experience with the FDA. I would say that if you have a policy that states what is done and if you follow your policy, you should be OK unless you get one of 'those' inspectors.

[David Saikin]

On ‎01‎/‎03‎/‎2018 at 11:23 AM, John C. Staley said:

Depends on the inspector!  Back in the day when I was inspecting, and yes it was called inspecting back then, I would not have even given it a second thought as long as the sample was acceptable and the unit was issued and hung prior to the expiration of the sample.  I have met those inspectors who would have been quite distraught over such a perceived infraction.  The best advice I can give you Mabel is, let your conscience and best judgement be your guide.  

What John said!  Some inspectors/assessors just do not get it.