Is darker-colored FFP safe to transfuse?

The Director of Operations at a national blood service in Southeast Asia writes that over the last year, they have noted some of their FFP is golden yellow in color, rather than the usual light pale yellow color of plasma. They are uncertain as to the reason for the discoloration, as there is no gross evidence of hemolysis in the blood bag. They have checked the bilirubin level and the result is higher than normal (Total Bilirubin ranging from 1.8 to 4.7). He continues:

We are thinking of the following possibilities:

1. The donor had previous subclinical hemolysis
2. The blood bag with the anti-coagulant is causing the abnormal color
3. The donors have hereditary non-hemolytic hyperbilirubenemia

They intend to follow-up with bilirubin levels on future donations from the same donors and ask: "What other possibilities should we think of? We are allowing returns due to abnormal coloring, but it is a big waste to throw away blood if the color doesn't affect the quality."

The following responses have been submitted.

1. Editors' Note: Colleagues might find the discussion, Is it permissible to release for transfusion a blood component that shows icteric plasma, drawn from a donor who is otherwise acceptable and whose hepatitis tests are negative? to be germane to the present question from Southeast Asia.

ADDENDA July 1, 2009

2. A Product and Hospital Services Director from our neighbors to the North points out: Both Canadian Blood Services (CBS) and the American Red Cross (ARC) have visual assessment guides for blood components. The CBS Guide (page 22) [English PDF, French PDF] indicates that the presence of icterus in a blood component is acceptable for transfusion, and may be caused in eligible HERE.

Submit Comments to the e-Network Forum below:

Items marked with an asterisk (*) are required entries. Please note that there is a 60 minute time-out on this form. if one anticipates taking more than 30 minutes or so to compose the submission, we recommend composing your comments in a word processing application, and performing a copy and paste of your text into the comments field.
* Name
Title
Affiliation
* email address
* Enter email address again to verify
* Do you wish to have attribution for your comments?	Yes No
* Your Comments
*Please indicate if this is a new question, or if you are commenting on an existing discussion:	New Question Existing, Name:
File Attachments (2MB limit)
To help us prevent SPAM, you must enter the the validation code EXACTLY AS IT IS DISPLAYED in the image directly to the right of the text entry field below in order to submit this form. Please note that the validation code is CASE SENSITIVE.

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

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