Transporting blood with patients

On June 3, 2000, the following question was submitted for discussion by the CBBS e-network:

"Our multihospital system sometimes transfers patients emergently between facilities. Rarely, we receive requests to transport blood with the patient to the receiving facility. Sometimes this is unnecessary, but one could imagine a scenario -- an aortic tear in a patient with multiple antibodies where the transferring facility has several compatible units but which the receiving one would not (in real time) be able to come up with - where unit transfer with the patient would be highly desirable. None of these facilities are donor centers and none ordinarily transport or ship blood. We have QC'ed coolers for use within the facilities, along with temperature monitors to affix to each unit. If this system is used to document a satisfactory shipment environment, are there licensure/FDA rules which would preclude this type of interfacility transfer? Do other non-donor center hospitals ship or accept such units directly from other hospitals? Our computer system is not configured to easily transfer units in this way, but manual comments can be entered. Our blood supplier is willing to allow this, so long as we maintain records that shipment conditions were within acceptable limits."

To which the following replies have been received:

1. At our blood center, we have a procedure that we have given to all our hospitals that details how to perform inter-hospital transfer. Inter-hospital blood transfers are done occasionally from our smaller hospitals to the larger trauma centers. We have a multi copy form that is to be used by the sending and receiving hospital and by us to track the units and transfer charges. We have given our customers validated boxes and packing instructions. We also include instructions for the transporting service in case transfusion occurs en route. It has been fairly successful. But we do have problems with the blood going from ER to ER and the labs are not aware of the transfer. Plus the units are not stored properly. In those situations, the sending hospital is still billed for the units, not the receiving one.
   
   (Editor's NOTE: Reply #1 does not address the important issue of how to address and solve the problem of ER to ER transfer of blood without the knowledge of the hospital blood bank. I wonder if there has ever been a transfusion reaction associated with such a transfer, and where the responsibility and liability would be placed.)
   
   
2. The issue here is not technical, because it's easy to purchase good shipping containers and continuous temperature monitors. Nor is the issue regulatory, because the FDA can define exactly what is and is not required in this situation. The issue is societal. That is, hospitals that accept patients and blood donors from the community should have blood bank licenses and/or registrations and written procedures in place to (be able to) readily transfer such a patient and compatible blood to another hospital. From my perspective in a large medical center, there's nothing more frustrating than to receive a telephone call from another hospital that collects and/or stores blood using minimal standards and ask if they can have the family bring the patient's autologous (untested) or other patient-specific (such as multiple antigen-negative) units when they come by automobile. Helping the questioner develop an SOP for how to collect, store and ship blood that qualifies for unplanned inter-hospital transfer will be a real service.
   
   
3. It would seem that common sense needs to prevail in such cases. We have two hospitals within 16 miles of each other. The Transfusion Services operate independently and we do not routinely transfer blood back and forth for either routine inventory purposes or for patients during transport. But I can easily see cases where an emergency situation could arise where blood would be transported with the patient if necessary. And of course, we would document all details. We've had a similar situation with cord blood issues when babies are transported but neither situations have presented problems, just lots of documentation to make sure the unit can be traced.

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Ira A. Shulman, MD
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W. Tait Stevens, MD
CBBS e-Network Forum Editor & Moderator

Elizabeth M. St. Lezin, MD
CBBS e-Network Forum Associate Editor & Moderator