Preparation and Issue for Transfusion
Issuing blood and blood products from the hospital transfusion service is a process whereby the final check of the product and patient identifying information may be made by laboratory staff. Critical steps such as final visual inspection of the product, documentation of the disposition of the unit, and the time and date of issue, are essential to process control.
If NOT Transfused Immediately
There must be a process in place to identify when the product left the controlled storage environment. Initiation of transfusion should begin within 30 minutes of issue from the hospital transfusion service unless the products are placed in a temperature monitored blood storage device. See Criteria for re-issue.
Careful comparison of the compatibility label, product bag label and request information should be performed by trained individuals.
Retention of Specimens
The time of issue is the last opportunity for the laboratory to retain a segment or representative sample of the donor unit.
- A sample from each unit received in the hospital transfusion service should be stored at 1-6°C for at least seven days post transfusion.
- Patient specimens should be stored at 1-6°C for a minimum of seven days after transfusion.
Transporting to the Patient Care Area
The messenger transporting the product from the laboratory to the patient care area has the responsibility to assure that the product is handed to a responsible person, preferably the transfusionist. Ideally the laboratory should be involved in training messengers to pick up blood products from the laboratory. The 1997-98 Serious Hazards of Transfusion (SHOT) initiative identified that collection of the wrong blood from the blood bank refrigerator was a major source of error.
Platelet Components
When a pool of random donor platelets is being used, most hospital transfusion services will pool platelets immediately prior to transfusion. Once pooled, the product must be transfused within four hours to avoid the risk of bacterial contamination. In normal circumstances, only one apheresis platelet unit, single random donor units in a dose of five (or fewer, for pediatric patients), or a pooled component is issued at one time from the hospital transfusion service.
Plasma Components
Frozen plasma may be thawed in a water-bath or in a microwave specifically designed for this purpose. When using a water-bath, frozen components should be placed in a watertight protective plastic over-wrap and thawed using gentle agitation. Careful examination of the component container is required to look for evidence of container breakage or of thawing during storage. Thawed plasma should be transfused within 24 hours.
Cryoprecipitate AHF, LR
Most hospital transfusion services thaw and pool cryoprecipitate immediately prior to transfusion.
The frozen product is thawed by placing it, covered by a watertight protective plastic over-wrap, in a water-bath at 30-37°C for up to ten minutes. The component should not be used if there is evidence of container breakage or evidence of thawing during storage. Cryoprecipitate should not be refrozen after thawing. Alternatively, this component may be thawed in a microwave specifically designed for this purpose.
For pooling, Cryoprecipitate is usually mixed with 10-15 mL of 0.9 per cent Sodium Chloride Injection (USP) to ensure complete removal of all cryoprecipitate from the bag.
Thawed, pooled Cryoprecipitate should be stored at 20-24°C and transfused within four hours.
See the Circular of Information for a complete description of:
- Cryoprecipitate AHF, LR Pooling (Dosage and Administration) Section F.6
- Cryoprecipitate AHF, LR Storage Section F.7