Transfusion medicine handbook

3. Guide to Good Transfusion Practice

3.11 Removal From Storage and Time Limits for Transfusion

It is important that blood components are transfused as soon as possible following receipt from the blood bank so that the required efficacy is achieved and unwanted bacterial proliferation is avoided.

Red Cells

• Transfusion should begin as soon as possible following removal of the unit from a monitored blood refrigerator or validated transport container.
• Transfusion of red cells should be completed within four hours of removal from a monitored blood refrigerator or validated transport container.
• Where a short delay occurs (or is anticipated) before starting a transfusion, red cells may be held at ambient temperature provided the transfusion can be completed within four hours of the blood being issued from a monitored blood refrigerator.
• If transfusion cannot be started within 30 minutes, the unit should normally be returned without delay to a monitored blood refrigerator for controlled storage.
• Red cells must be stored in a refrigerator that is manufactured and validated for the purpose of storing red cell components and has permanent temperature monitoring. They must not be stored in a ward refrigerator, domestic refrigerator or refrigerator intended for vaccine storage.
• If a unit of red cells has been out of controlled storage for more than 30 minutes and there is no prospect of imminent transfusion it should be returned to the blood bank for disposal. The unit cannot be accepted back into blood bank inventory.

Platelets

• Transfusion should begin as soon as the platelets are received from the blood bank.
• Transfusion of platelets should be completed within one hour of issue from the blood bank.
• If not used immediately, platelets must be returned to the blood bank and controlled storage within one hour of issue.
• Platelets are stored (usually in the blood bank) at room temperature (20 - 24 ºC) with constant agitation.
• Platelets must not be transported or stored in a refrigerator or chilled transport container.
• If platelets have been out of controlled storage for more than one hour, acceptance back into blood bank stock is conditional on evidence of suitable storage.

Fresh Frozen Plasma

• Transfusion should begin as soon as the thawed plasma is received from the blood bank.
• Transfusion of plasma should be completed within four hours of thawing.
• If the plasma is not going to be used or transfusion cannot be started within 30 minutes, it must be returned to the blood bank immediately. If returned within 30 minutes of issue, then it can be stored for up to 5 days at 2 - 6°C during which time it may be reissued to the same or a different patient. If not used within 5 days, the returned plasma expires.
• If the plasma has been out of controlled storage for more than 30 minutes, it cannot be accepted back into blood bank inventory.
• Once thawed, plasma must not be refrozen.

Cryoprecipitate

• Transfusion should be started as soon as the thawed cryoprecipitate is received from the blood bank.
• Transfusion of cryoprecipitate should be completed within four hours of thawing.
• If the cryoprecipitate is not going to be used or transfusion cannot be started within 30 minutes it must be returned to the blood bank immediately, where it can then be stored for up to 4 hours at ambient (room) temperature during which time it may be reissued to the same or a different patient. If not used within 4 hours, the returned cryoprecipitate expires.
• If the cryoprecipitate has been out of controlled storage for more than 30 minutes, it cannot be accepted back into blood bank inventory.
• Once thawed, cryoprecipitate must not be stored in the refrigerator nor should it be refrozen.