A blood banker in the Pacific Northwest reports that on occasion they will use sterile docking to remove a small aliquot from a unit of RBCs to transfuse a pediatric patient. After removing the aliquot, they are left with an almost complete unit of red cells (minus the aliquot). In the event other pediatric patients do not need further aliquots drawn from that unit, she wonders whether others use that nearly full RBC unit for an adult transfusion dose. In other words, to avoid wasting such a product, under what circumstances would colleagues give the nearly full RBC unit to another patient?

The following comments have been received.

ADDENDA July 29, 2004

1. The head of a hospital transfusion service in Southern California reports that at her facility they allow for the removal of an aliquot from a unit of RBCs and then use the residual RBC unit for adult transfusions. She comments "I can't imagine wasting a unit of group O Rh negative RBC. We have always done this no matter where I have worked!! That is why we order units with the satellite bags attached. I wonder why this is even a question?"

2. Editor's NOTE: While it is admirable to avoid wasting a precious resource, it would seem prudent to assure that a product from which an aliquot has been removed actually contains a sufficient dose to meet the needs of the patient who might receive that altered product. I wonder if those who do use RBCs (or other products for that matter) that have had an aliquot removed have validated that the residual product (i.e., minus the aliquot) still meets labeling claims for potency.

ADDENDA August 3, 2004 

3. A colleague in Texas reports that at her hospital the only units they stock for neonates are group O Rh negative leukoreduced, irradiated RBCs. When they prepare an aliquot for neonatal transfusion, they usually remove 20 - 60 mL from the RBC unit. She adds that when group O Rh negative RBCs are in short supply, it seems 'criminal' to waste almost a full unit, provided that less than 60 mL has been removed from it. Consequently, they transfuse what's left of the original unit from which an aliquot has been removed. They keep units from which an aliquot has been removed for as long as possible as a source of additional aliquots, but when such a unit is too old for neonates, they will transfuse the residual 'in date' RBC unit to another patient. On the other hand, if more than 60 mL has been aliquoted from the unit, and if the residual unit is no longer usable as a source of additional aliquots for neonates, the unit is discarded.

ADDENDA August 6, 2004

4. A transfusion medicine physician in Texas would like to expand this discussion to include platelet products. He reports that if a neonate required a platelet transfusion at his institution consisting of an aliquot from a plateletpheresis unit, after removing the aliquot they would like to give the remainder of the pheresis unit to an adult, presuming that the residual number of platelets is consistent with good practice. The Texan would like to know whether others are following this practice for plateletspheresis products.

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