Issues in storage of pre-transfusion samples

A colleague in Ohio asks transfusion services how long do they allow blood bank pre-transfusion samples be drawn before surgery? What is the community standard? If the samples are kept for 30 days, do IgG and complement levels deteriorate and can the samples be used for crossmatching?

Editors’ notes: AABB Standards state that if a patient has been transfused or pregnant within the preceding 3 months, a sample shall be obtained from the patient within 3 days of transfusion (AABB Standard 5.13.3.2). The Standards do not specify the length of time a pre-transfusion sample may be drawn prior to transfusion for other patients. Some institutions allow collection of pre-surgery crossmatch specimens up to 30 days before scheduled procedures. The Editors ask transfusion services to share their policies or protocols regarding pre-transfusion samples. Has your institution considered the following details?

1. How do you document whether the patient has been transfused or pregnant in the previous 3 months?
2. Do you allow use of a sample > 3 days old for crossmatching if the antibody screen is positive?
3. What do you do if there is a transfusion reaction work up and you need to re-type the patient’s pre-transfusion ABO type or perform antigen phenotyping on the patient RBCs. Does your manufacturer’s instructions /package insert allow for testing on a sample >3 days old in this situation?
4. Do you have a retention policy that requires samples be kept for at least 7 days after transfusion for both 3-day and extended storage samples? For example, if you keep samples 0 to 30 days and surgery (and transfusion) is on day 30, do you have a process for storing the sample for at least 7 more days after transfusion (AABB Standard 5.11.4)?

Previous discussions on the e-Network Forum also may be of interest:

• What is the experience with using pretransfusion blood samples that are routinely used for up to 10 days (or longer) after their collection?
• Methods for ensuring correct identification of patients who have pre-transfusion blood samples drawn before admission for surgery
• Antibody stability in plasma/serum samples stored in direct contact with red cells

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

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

Elizabeth M. St. Lezin, MD
CBBS e-Network Forum Associate Editor & Moderator