What is the expiry of a red cell unit if it is exposed to higher temp (more than 10 C) for more than half hour? 24 hours??

Maximum transport temperature is 10C. So if it is greater than that it gets quarantined and disposed. A pRBC can be exposed to a high temperature as in RT when being transfused, in this case transfusion has to be completed within 4 hours.

I agree with Justina . . . if not being transfused, once the temp goes higher than 10C - the unit is history. If it is out of the BB and returned it is incumbent on you to determine if the unit temp has exceeded the limit . . . there are a few ways you can accomplish this. Usually not more than 15 min before the blood can no longer be returned for reissue (except to the pt it was signed out for originally and then it must be infused in less than 4 hrs from the original sign out time).

What David said is correct. If you know the time it spent and at what temp then you may accept that it be transfused to that patient and deduct the time from the 4 hours. This goes back to the question of why we accept only 30 mins out and back at the acceptable temp and yet allow up to 4 hours of transfusion time. Same concept. Thanks Dave, I had archived that one in my brain.

PS: I would dispose of it. I err on the safe side.

PS: I would dispose of it. I err on the safe side.

agreed with liz

PS: I would dispose of it. I err on the safe side.

Me to - but not if it is going to be infused, right? . . Also consider - I believe the 30 min out of blood bank was when the blood was stored in glass bottles, not plastic bags. We have found temp rises pretty quickly - and do not accept back after 15 minutes.

I agree with Justina . . . if not being transfused, once the temp goes higher than 10C - the unit is history. If it is out of the BB and returned it is incumbent on you to determine if the unit temp has exceeded the limit . . . there are a few ways you can accomplish this. Usually not more than 15 min before the blood can no longer be returned for reissue (except to the pt it was signed out for originally and then it must be infused in less than 4 hrs from the original sign out time).

Dave, does the AABB agree with your exception? I'd love to do this, but I would interpret Standards to prohibit reissue to anyone if the temp was not maintained <10o.

Dave, does the AABB agree with your exception? I'd love to do this, but I would interpret Standards to prohibit reissue to anyone if the temp was not maintained <10o.

As long as the blood is being given to the pt it was originally signed out for AND it is infused within the 4 hr time frame of the original release time there is no problem (it's just like it hung for 4 hrs). This comment used to be in the standards - don't know if it is any longer but it only makes sense.

As long as the blood is being given to the pt it was originally signed out for AND it is infused within the 4 hr time frame of the original release time there is no problem (it's just like it hung for 4 hrs). This comment used to be in the standards - don't know if it is any longer but it only makes sense.

I agree that it makes perfect sense, but I've also seen that sense and strict interpretation of regulations are not always the same thing. By the way, neither Standards nor the Technical Manual really elaborate or comment on the issue.

Edited July 3, 201213 yr by Dr. Pepper

. . . if not being transfused, once the temp goes higher than 10C - the unit is history. If it is out of the BB and returned it is incumbent on you to determine if the unit temp has exceeded the limit . . . there are a few ways you can accomplish this. Usually not more than 15 min before the blood can no longer be returned for reissue (except to the pt it was signed out for originally and then it must be infused in less than 4 hrs from the original sign out time).

If it comes back to the BB we discard. If they call and ask I tell them they have 4 hours to infuse. If not infused by that time to return the unit to BB (So we can change our transfusion record... pt not got unit) or if started,

discard the balance of the unit at that time.

BUT if it comes back to blood bank and is warmer than 10 degrees.... its history. They will have to order a new unit if they want it. I don't reissue something that has been out of temp.

Our policy would be to not take the unit back but let the nurse keep it to see if she can get it in within 4 hours. I was taught 30+ years ago that it wasn't good for RBCs to warm and cool and warm and cool, but I have never heard that since my training. I don't like to take a spiked or out of temp unit back into my control although I am not entirely comfortable having a unit of blood just sitting around somewhere that someone could mistake it for uncrossmatched blood or something either.

To the original question, the unit would be discarded unless there was some huge medical justification to get a pathologist's approval to still use it. It would have to be autologous k neg or Bombay or something irreplaceable to justify overriding the regs.

I have a slight variation on this question. It was posed by my manager this morning. We had a severe storm Friday night and lost power for approx. 20 hours. The ambient temperature in the hospital was in the upper 90s. My manager's question was "Should we suspend all but emergency transfusions due to the room temp?"

Will the higher room temp increase the rate of hemolysis while the blood is hanging?

:cool::cool::cool::cool:

I think the main worry for blood hanging is bacterial growth . . . I've never heard of hemolysis during hanging . . .

Thanks David, my manager always wants to hear from another source.

Red cells seem to reside quite happily in our bodies at 98.6oF, so your temps of upper 90s should have been OK. The AABB Tech Manual gives a temp of 42oC (107oF) as the danger temp where hemolysis can start to occur.

And I doubt the rare bug that might be contaminating the bag will grow appreciably faster at those higher temps in the 2-3 hours of a transfusion either.