Transfusion medicine

• Information and tables are modified from Cohn: Technical Manual, 21st Edition, 2023

Red blood cell components (whole blood derived or apheresis derived) (FDA: CFR - Code of Federal Regulations Title 21 [Accessed 22 February 2024])

• Stored in plastic bags that contain anticoagulants, preservatives, with or without additive solutions
• U.S. Food and Drug Administration (FDA) requires in vivo labeling studies demonstrate that ≥ 75% of the transfused red cells remain in circulation after 24 hours with < 1% hemolysis
• Storage lesions are an accumulation of biochemical and morphological changes that occur during blood product storage
  • Morphological changes
    • Alterations in red cell membrane shape and deformability
    • Membrane vesiculation
  • Biochemical changes
    • Decreased pH, adenosine triphosphate and 2,3 diphosphoglycerate
    • Increased lysophospholipids, potassium and free hemoglobin

Blood product	Storage conditions	Transport conditions	Shelf life / expiration
Red blood cells (RBCs)	1 - 6 °C	1 - 10 °C	ACD / CPD / CP2D: 21 days CPDA-1: 35 days Additive solution: 42 days Open system: 24 hours
Deglycerolized RBCs	1 - 6 °C	1 - 10 °C	Open system: 24 hours Closed system: 14 days or as FDA approved
Frozen RBCs 40% glycerol	-65 °C or colder if 40% glycerol or as FDA approved	Maintain frozen state	10 years (a policy shall be developed if rare frozen units are to be retained beyond this time) Freeze within 6 days of collection unless rejuvenated Freeze before expiration if rare unit
RBCs irradiated	1 - 6 °C	1 - 10 °C	Original expiration or 28 days from date of irradiation, whichever is sooner
RBCs leukocytes reduced	1 - 6 °C	1 - 10 °C	ACD / CPD / CP2D: 21 days CPDA-1: 35 days Additive solution: 42 days Open system: 24 hours
Rejuvenated RBCs	1 - 6 °C	1 - 10 °C	CPD, CPDA-1: 24 hours AS-1: freeze after rejuvenation
Deglycerolized rejuvenated RBCs	1 - 6 °C	1 - 10 °C	24 hours or as approved by FDA
Frozen rejuvenated RBCs	-65 °C or colder	Maintain frozen state	CPD, CPDA-1: 10 years AS-1: 3 years (a policy shall be developed if rare frozen units are to be retained beyond this time)
Washed RBCs	1 - 6 °C	1 - 10 °C	24 hours

Whole blood components

• Used in situations requiring a combination of components, such as during massive blood loss or for certain surgical procedures
• Contain red cells, plasma and platelets
• Stored in plastic collection bags
• Subject to same storage lesions found in red cell components

Blood product	Storage conditions	Transport conditions	Shelf life / expiration
Whole blood	1 - 6 °C	1 - 10 °C	CPD / CP2D: 21 days CPDA-1: 35 days
Whole blood irradiated	1 - 6 °C	1 - 10 °C	Original expiration or 28 days from date of irradiation (whichever is sooner)
Whole blood leukocytes reduced	1 - 6 °C	1 - 10 °C	CPD / CP2D: 21 days CPDA-1: 35 days Open system: 24 hours

Granulocyte components

• Transfuse as soon as possible after receipt from blood center
• Always irradiate
• Should not be agitated

Granulocyte components	Storage conditions	Transport conditions	Shelf life / expiration
Apheresis granulocytes	20 - 24 °C	As close as possible to 20 - 24 °C	24 hours
Apheresis granulocytes irradiated	20 - 24 °C	As close as possible to 20 - 24 °C	No change from original expiration date

Plasma components

• Coagulation factor activity is affected by storage conditions and shelf life
• Plasma derivatives include products like immunoglobulins and albumin, used for immune deficiency treatment, volume expansion and various therapeutic purposes
• Cryoprecipitate antihemophilic factor (cryo)
  • Cryo is rich in clotting factors and is used to treat bleeding disorders, particularly hemophilia and fibrinogen deficiencies

Plasma components	Storage conditions	Transport conditions	Shelf life / expiration
Cryoprecipitated antihemophilic factor (AHF)	-18 °C or colder	Maintain frozen state	12 months from original collection
Cryoprecipitated AHF (after thawing)	20 - 24 °C	As close as possible to 20 - 24 °C	Single unit: 6 hours
Pooled cryoprecipitated AHF (pooled before freezing)	-18 °C or colder	Maintain frozen state	12 months from earliest date of collection of products in pool
Pooled cryoprecipitated AHF (after thawing)	20 - 24 °C	As close as possible to 20 - 24 °C	Pooled in an open system: 4 hours Pooled using a sterile connection device: 6 hours
Pathogen reduced cryoprecipitated fibrinogen complex	-18 °C or colder	Maintain frozen state	-18 °C or colder: 12 months from collection Post-thaw, 20 - 24 °C: 5 days
Fresh frozen plasma (FFP)	-18 °C or colder or -65 °C or colder	Maintain frozen state	-18 °C or colder: 12 months from collection -65 °C or colder: 7 years from collection (FDA approval required if product is stored for longer than 12 months)
FFP (after thawing)	1 - 6 °C	1 - 10 °C	If issued as FFP: 24 hours
Plasma frozen within 24 hours after phlebotomy (PF24)	-18 °C or colder	Maintain frozen state	12 months from collection
Plasma frozen within 24 hours after phlebotomy (after thawing)	1 - 6 °C	1 - 10 °C	If issued as PF24: 24 hours
Plasma frozen within 24 hours after phlebotomy held at room temperature up to 24 hours after phlebotomy (PF24RT24)	-18 °C or colder	Maintain frozen state	12 months from collection
Plasma frozen within 24 hours after phlebotomy held at room temperature up to 24 hours after phlebotomy (after thawing)	1 - 6 °C	1 - 10 °C	If issued as PF24RT24: 24 hours
Thawed plasma	1 - 6 °C	1 - 10 °C	5 days from date product was thawed or original expiration, whichever is sooner
Plasma cryoprecipitate reduced	-18 °C or colder	Maintain frozen state	12 months from collection
Plasma cryoprecipitate reduced (after thawing)	1 - 6 °C	1 - 10 °C	If issued as plasma cryoprecipitate reduced: 24 hours
Thawed plasma cryoprecipitate reduced	1 - 6 °C	1 - 10 °C	If issued as thawed plasma cryoprecipitate reduced: 5 days from date product was thawed or original expiration, whichever is sooner
Liquid plasma	1 - 6 °C	1 - 10 °C	5 days after expiration of whole blood
Recovered plasma (liquid or frozen)	Refer to short supply agreement	Refer to short supply agreement	Refer to short supply agreement (required)
Plasma pathogen reduced	-18 °C or colder	Maintain frozen state	12 months from original collection

Platelet components

• Used to treat bleeding disorders such as thrombocytopenia and to support patients undergoing chemotherapy or transplant procedures
• Storage bag must be semipermeable and allow diffusion of oxygen and carbon dioxide to maintain a pH > 6.2 (FDA: CFR - Code of Federal Regulations Title 21 [Accessed 22 February 2024])
• Metabolic, morphologic, functional changes define shelf life and storage conditions
• Shelf life limited by increased risk of bacterial growth
• Shelf life can be extended from 5 to 7 days using an FDA approved strategy (FDA: Bacterial Risk Control Strategies for Blood Collection Establishments and Transfusion Services to Enhance the Safety and Availability of Platelets for Transfusion [Accessed 22 February 2024])
  • Large volume, delayed sampling (LVDS) no sooner than 48 hours after collection
  • Use of a secondary culture of apheresis platelets no sooner than day 4 of storage in FDA cleared containers approved for 7 day storage
  • Secondary rapid testing of apheresis or prestorage pooled WBD platelets

Platelet components	Storage conditions	Transport conditions	Shelf life / expiration
Platelets	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	24 hours to 5 days, depending on collection system
Platelets cold stored	1 - 6 °C (agitation optional)	1 - 10 °C	14 days
Platelets irradiated	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	No change from original expiration date
Platelets leukocytes reduced	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	Open system: 4 hours Closed system: no change in expiration
Pooled platelets leukocytes reduced	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	4 hours after pooling or 5 days following collection of the oldest unit in the pool
Pooled platelets (in open system)	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	Open system: 4 hours
Apheresis platelets	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	24 hours or 5 days, depending on collection system
Apheresis platelets irradiated	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	No change from original expiration date
Apheresis platelets leukocytes reduced	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	Open system: within 4 hours of opening the system Closed system 5 days or 7 days
Apheresis platelets platelet additive solution added leukocytes reduced	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	5 days
Apheresis platelets pathogen reduced	20 - 24 °C with continuous gentle agitation	As close as possible to 20 - 24 °C Maximum time without agitation: 30 hours	5 days

Which of the following statements is true regarding the shelf life and storage conditions of red blood cells (RBCs)?

1. RBCs have a shelf life of 21 days when stored in citrate phosphate dextrose (CPD) at 1 - 6 °C
2. RBCs have a shelf life of 35 days when stored in citrate phosphate double dextrose (CP2D) at 1 - 6 °C
3. RBCs have a shelf life of 35 days when stored in citrate phosphate dextrose adenine 1 (CPDA-1) at 1 - 10 °C
4. RBCs have a shelf life of 42 days when stored in CPD and additive solution at 1 - 10 °C

A. RBCs have a shelf life of 21 days when stored in CPD at 1 - 6 °C. Answer C is incorrect because RBCs must be stored between 1 and 6 °C. Answer B is incorrect because storing RBCs collecting in CP2D has a shelf life of 21 days. Answer D is incorrect because storing RBCs at 1 - 10 °C is not a recommended storage temperature.

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Reference: Shelf lives of products

Which blood product has the shortest shelf life?

1. Apheresis platelets stored at room temperature
2. Cryoprecipitate stored at -18 °C
3. Fresh frozen plasma (FFP) stored at -18 °C
4. Red blood cells (RBCs) stored at 1 - 6 °C

A. Apheresis platelets stored at room temperature. Among the options listed, platelets have the shortest shelf life. They are most often stored at room temperature and have a shelf life of only 5 days. This shelf life can be extended to 7 days in certain circumstances outlined by the FDA bacterial contamination mitigation strategies. Cold stored platelets can have a longer time to expiration based on manufacturer's instruction. Answers B, C and D are incorrect because these blood products have longer shelf lives compared to platelets. FFP is stored at -18 °C or colder and can be stored for up to 1 year. Cryoprecipitate is derived from FFP and has a shelf life of 1 year when stored at -18 °C or colder. RBCs in liquid form have a shelf life ranging from 21 to 42 days depending on the anticoagulant, preservative and additive solution used.

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Reference: Shelf lives of products

What is the maximum allowable storage time for cryoprecipitate when stored at -18 °C or colder?

1. 1 year
2. 2 years
3. 6 months
4. 18 months

A. 1 year. Cryoprecipitate, when stored at -18 °C or colder, has a maximum allowable storage time of 1 year. This ensures the preservation of its clotting factor content. Answers B, C and D are incorrect because they either do not meet or exceed the recommended storage time for cryoprecipitate.

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Reference: Shelf lives of products