Best Practices for Blood Storage and Handling

I am a Registered Nurse by training. I retired after 30 years working in acute care hospitals, clinics, and public health. During that time, I worked directly with patients, served in management roles, participated on committees, and helped develop policies and procedures.

I share that background to make one thing clear: I am not a blood component specialist. But after researching this topic, there are several things I wish I had known when I worked in a surgical ICU years ago.

I administered countless blood components over the years. I was trained to keep units cold until use, call the blood bank when more was needed, and arrange pickup for unused components. I was told not to let packed red blood cells get too warm, not to administer them too cold, and not to let them hang for more than four hours.

We warmed cold blood next to the body or used warm water baths in old-style blood warmers. We used pressure bags to administer blood quickly. We were also expected to remind the physician when more than four units of red blood cells had been given so coagulation status could be evaluated.

Most of our other protocols focused on correct identification of both the blood product and the patient. Is this the right patient? Is this the right blood? Did two licensed staff members cross-check everything? What I do not remember is consistently recording component temperatures or time out of storage.

While much of my research uncovered highly technical studies on chemical and functional changes in donated blood—such as the effects of component separation, storage age, and handling—one point is clear: blood banks and any department storing blood components, even for short periods, should have documented storage conditions and chain-of-custody temperature data as a best practice for patient care.

U.S. medical workers administer about 14.7 million units of blood to approximately five million patients each year to treat anemia or replace blood loss. NIH National Heart, Lung, and Blood Institute (NHLBI), www.nhlbi.nih.gov, 10-31-2017.

Standards are available for purchase from AABB, formerly the American Association of Blood Banks, at www.aabb.org.

In essence, different blood components have different storage requirements.

• Platelets are stored at room temperature and must not be placed in a refrigerator.
• Refrigeration and storage units must be specifically designed and operated for blood product storage.
• Blood products should only be stored in these refrigerators when there is clear assurance that the units are functioning correctly and consistently.
• Handling refrigerated components outside of main storage should be kept to a minimum to ensure maximum temperature limits are not exceeded.
  • Red cell components must not exceed 30 minutes at room temperature on each occasion.
  • Blood components should remain in a controlled temperature environment until administered.
  • Components should be handled and stored in a way that minimizes the risk of product tampering.
• Audible alarms that alert staff when temperatures are out of range are considered a best practice.
  • Store red cells between 2°C and 6°C.
  • Store platelets between 20°C and 24°C.
  • Store fresh frozen plasma, cryo-depleted plasma, and cryoprecipitate at or below -25°C.
  • Set alarm trigger points within 0.5°C of the required storage temperature range.

So when it comes to blood component logistics, what is the easiest way to control what is controllable?

First, make sure the right infrastructure is in place to properly manage the blood supply, including:

• Obtaining the cold chain record for every component received, including all necessary supporting documentation.
• Having the required purpose-built storage units available and functioning properly.
• Ensuring temperature recording devices are certified and calibrated, with certificates and temperature records readily accessible.
• Having transport protocols in place that maintain and verify cold chain integrity by using temperature data loggers that record time in transit and alert qualified personnel to problems before wastage occurs.

Second, thoroughly train staff on your institution’s blood storage and transportation requirements.

Third, work with a knowledgeable and competent vendor to help ensure safety for patients, staff, and the institution.