The acceptability of storing an allogeneic unit on the autologous blood shelf

A colleague from a Southern California transfusion service asks the following question, which arose stemming from an incident where an allogeneic unit was issued to a patient, even though there was one autologous unit still on the shelf. Although FDA prohibits autologous units from being commingled with the allogeneic blood supply, they aren't aware of any regulation that states you can't place an allogeneic unit with autologous units. In order to prevent the aforementioned situation from reoccurring, one of the changes his facility is considering is to rubberband the autologous unit(s) and any allogeneic units requested during the initial compatibility testing request together and place them on the autologous shelf. This would prevent an allogeneic unit from being dispensed first, and would also address the situation where an autologous unit was dispensed to the O.R., returned to the transfusion service unused, but its status not updated in the computer. Upon request for issue of another unit, the computer would display that the autologous unit had been transfused. Using the suggested protocol, the technologist would look for the crossmatched allogeneic unit, and not finding it on the allogeneic shelf, would then check the autologous shelf and find that one or more autologous units were still available.

The submitting colleague would be interested in finding out whether any other institution is using such a fail-safe mechanism, as well as if anyone is aware of any regulatory prohibition that would prevent them from pursuing this protocol.

The following comments have been received.

ADDENDA July 20, 2004

1. A colleague reports that at their institution, they do not separate autologous from allogeneic RBC units after the units have been crossmatched for a patient. They have a shelf in their blood bank refrigerator where these crossmatched units are placed.  They place the autologous units closest to the front of the refrigerator with the shortest dates at the very front. The allogeneic units are placed immediately behind the last autologous unit.  They keep the allogeneic units separated from the autologous, but they were cited by JCAHO for not having 'directed units' kept apart from the autologous.  As a corrective action they have placed a box on the same shelf assigned for the directed units. They use a log for documentation and clearly mark AUTO on the log; the units are listed on the log in order of intended use, to parallel the arrangement in the refrigerator. The responding colleague's concern is that if a patient leaves the hospital and does not use his/her autologous units during that admission, in the event they return to the hospital for transfusion for further transfusion therapy, their autologous units (if still in-date) may go unnoticed.  This oversight apparently does happen on rare occasion. What might be a corrective action to prevent this type of oversight?

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