Origin of 4 hour rule for completion of infusion?

The supervisor for a regional medical center in the Central Valley writes: "The Circular of Information For the Use of Human Blood and Blood Components (Revised December 2009) specifies a rate of 4 hours or less for the infusion of a blood component. Does anyone know the origin of this 4 hour rule? Is it evidence-based? Are there reported adverse consequences associated with an infusion lasting for 4.5 hours, 5 hours, 6 hours? I don't find any reference to 'infusion of blood exceeding 4 hours' in the Side Effect and Hazards For Whole Blood and All Blood Components section on pages 5-10. How do you handle an infusion that lasted over 4 hours in your facility? Document with variance/occurrence report? Does anyone consider it a sentinel event?"

The following comments have been received in response.

ADDENDA Dec. 19, 2010

1. A medical technologist writes: "At our hospital in NE WI, we would ask that the transfusing dept transfuse what they could in 4 hours, and waste the rest. Typically, we try to avoid this situation by having blood supplier dock sterile bags to the unit, so we can split it in half, so that we only transfuse 1/2 over 4 hrs, then they can call for the other 1/2 later."
   
   
2. Editors' note: The prior discussion, When infusion of a blood component is begun just before its expiration date but not completed at the time of expiration, must the infusion be terminated? may be germane to this dicussion.

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