Addition of sterile saline when pooling cryo

[Tympanista]

Is it standard procedure to add a small volume of saline when pooling cryo in order to aid with resuspension of the precipitate?  At my previous job we did not add saline, but I just began working at a different hospital and their procedure calls for the addition of approx. 30mL of saline to the first bag.  I'm not against the addition of the saline, but we have several patients who receive routine transfusions of cryo  (up to 36 units at a time).  Adding saline to the first bag and then using the contents of each subsequent bag to resuspend the next bag is very time consuming.  The procedure at my previous employer was to just spike into each bag and drain as much of the contents into the transfer bag as possible.  This was much less time consuming.  Is the recovery of the precipitate significantly increased by the addition of saline and subsequent resuspension of each bag with the previous bag's contents (i.e. enough to justify the added time involved)?  I'm just curious to hear what other facilities are doing.

[R1R2]

we purchase pooled cryo from the blood center.  no more pooling

 

[BankerGirl]

We also order only pooled cryo from our supplier, but our previous pooling procedure stated that a small amount of sterile saline should be added to each bag after adding it's contents to the pool bag to remove additional cryo.  At the facility where I trained, we did not do that.  I don't know if the additional recovery is worth it or not.

[carolyn swickard]

We get pooled cryo now too, but we did have a procedure where we added a little saline (10 mL) to the first bag and then over time, for the subsequent bags, only added a little of the pool back (10 ml or so) to help with recovery from the subsequent units (instead of a lot of the diluted unit or transferring the whole volume to each new unit, if that is what you are saying).  That could save you some time.  One does worry about whether either procedure is worth it.  Ask you distributor if they have pooled units - marvelous product!!

[mcgouc]

I only used the cryo pooled by the blood center for the last several years and agree it is marvelous although it may be cost prohibitive if you give a lot of cryo.  In the past, blood centers could make what we called "dry" cryo or "wet" cryo.   If your blood center only makes the "dry" cryo, there is a very small volume in the bag and it is necessary to add sterile saline to the first bag and pool as you described.   "Wet" cryo did not need additional saline added.  Years ago, our local blood center switched to "dry" cryo for a while and the hospitals had them switch back to "wet" cryo because of the additional documentation, time, and expense required with obtaining and adding the saline to the bag.  

[Lucky Jack]

In this process how is the saline physically added (sterile docked, spiked, syringe)? I've pooled cryo but never with saline. When I was on the hospital side we did get pre-pooled cryo from our blood supplier but still occasionally pooled when a provider insisted on a number of units that wasn't a multiple of 5.

[marvy1]

Unfortunately in Canada, we cannot get pre-pooled cryo from our supplier. AABB Tech Manual does mention adding saline to aid in the pooling process which is what we do. I haven't done studies, but I would guess a substantial amount of cryo would get left in the bags without the help of saline to "rinse" it out.

[Townsend]

We use both pre-pooled cryo from our blood supplier and in-house pooled cryo.  We are a pediatric hospital, so we may pool only one or two units depending on patient weight.  We do not add saline to the pooling process, and there is very little cryo left in each bag.  I am curious - what diagnosis or indication requires 36 units of cryo?  I would like to learn a bit about that.

[David Saikin]

We always added some saline when pooling cryo.  A moot point nowadays.

[AuntiS]

In Canada - CBS abandoned going the pooled cryo route since the trend is to move away from cryo and use fibrinogen concentrate instead.   I'm actually in the process of doing just that at our hospital.    We use a small amount (around 50mL) when pooling as per AABB.  I can't imagine not using saline to get all the sticky bits out!

Do you have a patient with a rare factor deficiency who is using all this cryo?  Interesting!

sandra

[Tympanista]

On ‎10‎/‎29‎/‎2018 at 10:26 PM, Lucky Jack said:

In this process how is the saline physically added (sterile docked, spiked, syringe)? I've pooled cryo but never with saline. When I was on the hospital side we did get pre-pooled cryo from our blood supplier but still occasionally pooled when a provider insisted on a number of units that wasn't a multiple of 5.

We spike a bag of saline to add to the pooling bag.  I would love to switch to pre-pooled cryo, but our supplier only offers 5-pools, and the physician caring for our regular cryo patients insists on 6, 12, or 36 units, depending on the patient.  : (

[Tympanista]

On ‎10‎/‎30‎/‎2018 at 10:39 AM, Townsend said:

We use both pre-pooled cryo from our blood supplier and in-house pooled cryo.  We are a pediatric hospital, so we may pool only one or two units depending on patient weight.  We do not add saline to the pooling process, and there is very little cryo left in each bag.  I am curious - what diagnosis or indication requires 36 units of cryo?  I would like to learn a bit about that.

Both patients have afibrinogenemia.  I am also curious as to why they are still receiving cryo, as opposed to a fibrinogen concentrate, but my pathologist is not very experienced when it comes to transfusion practices.

[DPruden]

On ‎11‎/‎5‎/‎2018 at 1:25 PM, Tympanista said:

Both patients have afibrinogenemia.  I am also curious as to why they are still receiving cryo, as opposed to a fibrinogen concentrate, but my pathologist is not very experienced when it comes to transfusion practices.

There is a huge price difference between cryo and fibrinogen concentrates, maybe that has something to do with it.

[slsmith]

It depends what the supplier is sending you. When we use to get single cryoprecipitate that the supplier called a "button" we put sterile saline in it to make it more liquid. Now it is all liquid ( of course when thawed). The pooled cryoprecipitate( 5 CP) is all liquid , not saline added 

[MAGNUM]

I purchase 5 unit pools of cryo from the blood supplier, no more pooling. The physicians seem to appreciate the pools. I do keep 1 or 2 units of AB cryo for emergent situations such as liver lacs and such to be used as emergent glue.

[Sonya Martinez]

We started adding 10mL of sterile saline which comes in a syringe already and we spike the first unit in the pool with a device that has a spike on one end and a syringe port on the other.  The reason we started is because it's in the Circular of Information for the Use of Human Blood and Blood Components "Cryoprecipitate AHF may be transfused as individual units or pooled.  For pooling, the precipitate in one or more concentrates should be mixed will with 10 to 15 mL of diluent to ensure complete removal of all material from the container.  The preferred diluent is 0.9% sodium chloride."  This was noted (not a deficiency) in my last CAP inspection in fall 2019 but on by AABB inspection the spring 2020 the inspector was really surprised.  I showed her the circular and she said she'd have to look into it for her institution.  We pool anywhere from 3-10 units in a single pool because we're a children's hospital.  We could get pre-pooled from our blood center but they only come in 5 and 10 unit pools.  We have a heart surgeon that likes pools of 4.