A technologist in Massachusetts reports that her hospital transfusion service is asked about once or twice a month by an orthopedic surgeon to freeze autologous blood that is at risk of expiring because a surgery is postponed beyond the original expiration date of the autologous blood. The surgeon's patients usually donate 2 units of autologous blood for their upcoming surgery. The technologist wonders if other facilities freeze autologous blood to prevent the units from expiring, if surgery is postponed, or if the units are allowed to expire. The inquiring colleague acknowledges that her hospital currently stores frozen blood for ten years, but their current medical director would like to discard frozen autologous units after the rescheduled surgery has taken place and the patient is no longer in need of the blood. The inquiring colleague was wondering if other hospitals freeze autologous units in this situation, and if so, do they charge a storage fee, and how long they keep them?

The following comments have been received.

ADDENDA May 8, 2006

1. A Transfusion Service Manager in Houston, Texas reports that her facility used to freeze autologous blood and charged a small storage fee of $25 for 6 months. They did not keep frozen RBCs beyond 1 year, because of lack of storage space. If extended storage was needed, they recommended that the patient contact the regional blood center. Because autologous units were frozen so infrequently (only 2-3 times per year), their staff could not maintain competency in the freezing procedure, so they discontinued freezing autologous RBCs. In place of that procedure they started to 'rejuvenate' autologous units within 3 days of expiration, if needed. This procedure also was seldom used and they would expire reagents. They discontinued the rejuvenation procedure in 2005. To make a long story short, the responding colleague's institution currently discards autologous units at expiration. If for some reason the patient's surgery gets postponed and the unit expires, the patient must redonate, and this is communicated to them at the time of the blood donation. The number of autologous donations they receive has declined and they currently get an average of 13 autologous donations per month and expire about 50% of them.

2. The Director of Technical Services at a Community Blood Center/Community Tissue Service in Dayton, Ohio, reports that his facility will freeze autologous RBC in the event that the donor/patient's surgery is postponed beyond the liquid shelf life of the product. However, it is their policy to NOT hold these frozen products indefinitely. They regularly review their inventory of frozen autologous blood and send a letter to the patient's physician after six months of frozen storage. The letter identifies the patient and the unit number (or numbers) of products frozen for the patient. The letter asks the physician to respond and indicate if the frozen products should be held for an additional six months, or be discarded if they are no longer needed. The letter states that if no response is received from the physician, the products will be discarded on or after a certain date (usually one month later than the date of the letter). Using the aforementioned approach, he reports that they have had very good success with this process. Few products are kept beyond the 6 month time period.

3. A medical technologist in San Bernardino reports that when surgeries are postponed, with or without a new surgery date, her blood collection center is often asked to freeze the autologous units. When requested to freeze an autologous unit, they determine if the unit can be frozen (i.e. not a low volume unit nor containing a cold agglutinin). If the product can be frozen, they request payment for the freezing/storage (1 year) and eventual thawing of the product. Once payment is received (or approved if covered by insurance), the unit is frozen. If the surgery is rescheduled, they hold the unit until the surgery is over. If the surgery is not rescheduled, the unit is stored frozen for one year, after which the donor is contacted to determine if they want the unit to remain frozen. If so, the patient is billed for another year of storage. In the responding colleague's experience, most donors either forget they have a frozen unit or don't want to pay for the storage beyond one year.

ADDENDA May 17, 2006

4. A Chief Medical Officer at a blood center in Texas reports that they only freeze autologous red cell units that meet the following criteria:

1) The surgeon requests it AND
2) The donor (patient) will not be able to re-donate because of a change in health status AND
3) The hospital agrees to pay for the freezing charges

OR
1) The unit is a rare blood type or the patient is one for whom compatible blood is hard to find

The reportedly hold the units frozen for 90 days unless special arrangements are made. Longer storage will incur additional storage fees.

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