When Red Cells are dispensed in a syringe, what is their expiration?

The following question was distributed to the e-network: Assuming a unit of RBCs was prepared in a closed system, what expiration do you give to RBCs if they are dispensed in a syringe? I've heard that since a syringe is not a licensed storage container the expiration should be 4 hours. We currently give our RBCs in a syringe an expiration of 24 hours. We are considering switching to the Charter syringe set, but one of their sites (not in California) indicated they give products shorter expiration times, not because of the container issue but because the product was filtered through this set. What are other sites doing?

To which the following replies were received:

1. ONCE YOU PREPARE A SYRINGE, WHY WOULD YOU WANT TO HAVE A LONG (24 HRS) EXPIRATION? YOU CAN STERILE DOCK ON PEDI BAGS AND THEY HAVE THE SAME EXPIRATION AS THE ORIGINAL UNIT.
   
   
2. We have used the Charter Medical system for over 8 years and have never used syringes. Instead we have 6 bags sterile docked to the unit. Life is much simpler!
   
   
3. We prepare aliquots just before they are to be transfused so even though we document a 24 hour expiration time on the label they are infused within 4 hours of preparation. We use the Charter Medical syringe filters. I don't believe that the issue of 24-hour expiration time has anything to do with whether the storage container is licensed or not but rather it is an issue of the risk of bacterial growth and contamination in an open system. I would be interested in comments related to the issue of the Charter Medical syringe filter. If the filtered red cells were from a prestorage leukoreduced unit would you expect to see microaggregate formation from any remaining leukocytes? Has any one performed any studies? Platelets don't aggregate at 4^oC but are they capable of just "sticking" together? Could this happen within 24 hours?

Editor's Note: Additional information can be found at the Charter Medical website.

ADDENDA Jan. 3, 2007

4. A medical technologist who is involved in quality assurance oversight at a hospital in Iowa reports that her transfusion service currently draws aliquots of red cells into syringes from multi-pack units for small volume transfusions of neonates. She acknowledges being unable to find any specific regulations on the allowed storage time for these aliquots other than to limit the storage to 24 hours at 4°C, since the aliquots would be in an open system. In most cases the aliquoting into a syringe is done shortly before issue, so that most of the time the aliquoted red cells would be used within 4 hours. She wonders what are other institutions' policies regarding the use and storage of syringe aliquots of red cells, and what are these policies based upon.

ADDENDA Jan. 4, 2007

5. A Transfusion Service Supervisor in Utah reports that at his facility they have an active 36 bed NICU where they provide small volume aliquots in syringes via sterile docking. The syringe set contains a filter so the nurses do not filter at the time of transfusion. Their syringe aliquots have a 24 hour outdate, but if it is more than 4 hours from aliquoting to issue the syringe is dispensed with a filter set for transfusion. The respondent adds that the reality is they load the syringe when the transfusion is requested and the blood is sent up immediately; seldom if ever is there a time lag between loading the syringe and issuing it for transfusion. He concludes stating that "Audits indicate that the transfusions are routinely started within 15 minutes of issue and completed in less than 4 hours from issue."

ADDENDA Jan. 5, 2007

6. Ellen Eagan, the Blood Bank Day Shift Supervisor at UCSF (attribution used with permission) reports that they prepare RBC and platelet aliquots in the Charter Medical Neonatal syringe. They sterile dock the syringe to the unit. The RBC syringe has an expiration of 24 hours and the platelet syringe has an expiration of 4 hours based on the recommendation that Charter Medical reportedly gave to UCSF.

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