A Laboratory Clinical Coordinator in New Jersey reports that surgeons at her hospital are requesting a change in the current expiration date for blood bank samples. Their current policy is to limit to 3 days how long a pretransfusion sample can be used for all inpatients, and for any outpatient who has a history of recent transfusions or pregnancy (or the history is unknown). Pretransfusion samples for outpatients who have signed a form indicating that they have not been pregnant or received blood products in the previous 3 months are 'good' for 10 days. The surgeons are requesting that the aforementioned policy be changed to permit pretransfusion samples to be 'good' for 10 days for all patients (including inpatients) who have a clear history of no transfusion and no pregnancy in the preceding 3 months. The inquiring colleague realizes that what the surgeons are requesting is compliant within AABB Standard (23rd edition) 5.13.3.2 which states "If the patient has been transfused in the preceding 3 months with blood or a component containing allogeneic red cells, has been pregnant within the preceding 3 months, or if the history is uncertain or unavailable, a sample shall be obtained from the patient within 3 days of the scheduled transfusion. Day 0 is the day of draw", but wonders if other facilities are using samples up to 10 days old as a routine. Colleagues who routinely permit blood samples to be 'good' for more than 3 days for pretransfusion testing are encouraged to share your experiences.

Editor's note: Colleagues might find the discussions:

• Previous e-Network Forum Discussion: Management of pre-admit surgery patients known to have previously identified antibodies
  and
  
• Shulman IA, Nelson JM, Nakayama R. When should antibody screening tests be done for recently transfused patients? Transfusion. 1990 Jan;30(1):39-41.
  

to be germane to the present discussion.

The following comments have been received.

ADDENDA June 24, 2006

1. A transfusion medicine physician in Rochester, NY reports that for their patients with no history of transfusion or pregnancy in the previous three months, they routinely use specimens for pretransfusion testing that are up to 14 days old. On a case by case basis and with blood bank physician approval, they will extend a specimen's expiration beyond 14 days. They test each pretransfusion sample either on the day of its receipt, or the next day, and then hold that sample to be used for any pre-, intra- or immediately post-op transfusion needs in that setting. The New York physician reports that they have been using this approach for approximately 10 years with good success and no known problems.

2. A Texas blood banker reports that about two years ago the surgeons at her hospital requested that all qualifying pretransfusion samples be 'good' for 10 days. Interestingly, it became the blood bank's responsibility to make sure that each patient had not been transfused or pregnant within the previous 90 days!!! To comply, they added the following "query" which had to be answered before an order could be placed into the computer.

Query: "Has the patient been transfused or pregnant in the last 90 days".
The choices to answer the query included: YES, NO or UNKNOWN.

If the query was answered YES or UNKNOWN, the pretransfusion sample was good for 3 days. If the query was answered NO , the pretransfusion sample was good for 10 days. There was a learning curve, but within 6 months, the query was being answered appropriately. They have had good success with this ordering process for almost 2 years.

ADDENDA June 26, 2006

3. A transfusion medicine physician in Houston, Texas reports that for the past year or so, her academic medical center has been routinely saving samples for crossmatch use up to 30 days after collection for patients who have no history of transfusion or pregnancy within the past three months, provided that the saved sample shows no allo- or autoantibodies or any other problems for the transfusion service.  Because they have a large number of Bone Marrow or progenitor (cord and/or stem) cell transplants, it is a routine to check the patient's prior medical history as well.

ADDENDA June 29, 2006

4. A colleague in Georgia reports that for more than a year they have had a policy allowing collection of pretransfusion samples for compatibility testing up to 10 days prior to scheduled surgery. If a surgery is scheduled on the 10th day and if RBC units are crossmatched, the crossmatched units are held for the patient until noon on day 11. The aforementioned policy reportedly has helped relieve 'bottlenecks' early in the morning when the lab receives last minute Type and Screen or crossmatch requests for patients who have been admitted to surgery that same day. They also use a commercial 'Phlebotomy software' that permits then to identify the patient and print bar code specimen labels at the patient's bedside. At the time that a Preadmission Testing (PAT) blood sample is drawn for the blood bank, the patient signs a form (that is charted) verifying no pregnancy or transfusion within the past 90 days. A 'Blood Bank Bracelet' is completed by the nurse who collects the PAT specimen. The PAT's are kept in a separate rack pending the scheduled surgery. Crossmatches are done the day before surgery using the PAT's, and transfusion slips are sent to the Pre-Op area to be placed in the patient's chart. The patient's Blood Bank Bracelet is sent to the Pre-Op area attached to a 3" X 5" card that has the patient's name, blood bank ID bracelet #, tests done. On day of surgery, the Pre-Op nurse 'verifies' the patient's identity at the bedside both verbally and by using the patient's admission bracelet which is attached to their wrist at the time of their surgical admission. The Pre-Op nurse initials the information on the Blood Bank Bracelet signifying that the correct Blood Bank Bracelet has been attached to the patient. The Georgian reports that the above process has helped identify antibody problems and allowed them to meet the patient's need effectively, as well as communicate with the physician prior to surgery. His perception is that their process is very tightly controlled and the patients don't have to keep the bracelets with them or bring them back with them on the day of surgery.

Please submit comments to the e-Network Forum.

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