Dispensing blood products for neonates in a syringe and compliance with ISBT labeling requirements

A California colleague reports that her hospital currently dispenses blood products in syringes for neonatal transfusions (RBCs, FFP, Cryoprecipitate and platelets). Before transferring the product to a syringe they filter it using a pediatric syringe set with a 150 micron filter. The inquiring colleague has heard that several institutions are considering discontinuing the use of syringes for neonatal transfusions because it is time consuming to prepare a syringe with product labels that will meet ISBT requirements. These institutions 'feel' it would be a easier and safer if nursing staff filtered the blood product at bedside. This would mean that the blood bank would issue the product aliquot in a standard product container, such as is delivered from a blood supplier. She would like to know if any facilities who currently issue blood products in a syringe are likely to discontinue this practice once ISBT is implemented.If so, what explanation will be given to the Medical staff and hospital administration in order to achieve 'buy in' to change the practice. The inquiring colleague laments that since the NICU at her facility is used to the product in a syringe, it is going to be a difficult change to accept, unless there is a good reason to do so.

The following comments have been received.

ADDENDA July 12, 2007

1. A transfusion medicine colleague in Michigan comments that in her opinion the use of (or the decision not to use) syringes for neonatal transfusions is NOT an ISBT-128 issue. She points out that machine readable labels have already been required for over a year for all blood components prepared by the blood bank, including syringe containing blood products.
According to 21CFR 606.121 (c) (13) (iii)
Each label must have machine-readable information that contains, at a minimum:
(A) a unique facility identifier;
(B) Lot number relating to the donor;
(C) Product code; and
(D) ABO and Rh of the donor.

She believes that a decision to discontinue the use of labeled syringes for neonatal transfusions should be based on what is best for meeting patient care needs, and not be based solely on how much effort is required to put a machine readable label on a syringe. She asks if it is better for a blood bank to issue a labeled aliquot (in a transfer bag) to the neonatal care area, only to have nursing staff draw some of the product from the transfer bag into an unlabeled syringe? She has seen this practice occur. In her experience, a 60 mL syringe is convenient as a transfer syringe, since it is easy to handle and label. Most pumps can accommodate this size syringe.

ADDENDA July 16, 2007

2. A colleague in the Pacific Northwest reports that her institution implemented ISBT labeling in November of 2006, and that they did not change their method of providing syringe aliquots to the NICU. In fact, she states that their labeling process has become much easier and faster with this implementation. They use a computer system which 'modifies' the units into aliquots and permits ISBT labels to print from a Digi-Trax printer.

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

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator