Recently, a patient in Gulbarga needed a unit of Ab-ve to survive. It was urgent, the patient’s life was at stake. Blood was available in neighboring Raichur district. In another incident, a Bombay group unit that was available at Manipal was transfused to a patient in Bangalore. In both these cases, Blood was required to be transported.
Although we will not go into the specifics of what happened in each of these cases, we will take a look at some basic steps that needs to be followed to move critical units of blood across blood banks and storage centers. Although this article largely focuses on movement of individual blood units by common people, the same principles can be applied for transportation of blood units by members of the medical fraternity also.
In an ideal case, every blood unit that is moved (from donor side to storage center or storage center to patient bed side) needs to adhere to the basic rules that are mentioned in this article. However, in a practical sense, in India, blood components are usually transported for one of four reasons:
- To supply a hospital with blood products
- To redistribute blood components that are nearing expiry to places where consumption is expected
- To accompany a patient en route to another facility To transport components within a hospital to the patient care area
The following tips if followed will ensure a best suitable environment for the blood unit being transported
- Maintain Proper Temperatures: Maintaining proper storage temperature during transportation is essential to maintain therapeutic efficacy, life span of the constituents and to prevent bacterial over growth. The allowable temperature limit for refrigerated blood components is up to 10 ºC during transportation but the preferable range is 1-6 ºC. Blood transport Boxes or Cold Chain Boxes should be used for whenever blood is moved from the blood center to patient bed side or operation theater. It is important to use clean and sturdy transport boxes that maintain optimum temperature required for blood during transport. Each blood transport box requires frozen ice packs in order to ensure an acceptable cold life. Pre-filled ice packs are not normally recommended. They contain a eutectic agent that may have a lower freezing point than water, thusendangering whole blood or packed red cells whichshould never be frozen.
- Usage of Special Coolants : The coolant is a eutectic
solution that has tremendous thermal energy capacity and stability at its thermal phase change temperature, typically +16° to +20°C. The coolants are kept at +4°C when they solidify, and are ready for use after two hours at room temperature. This phase change from solid to liquid thermally protects blood or platelets, and is far more efficient than ice/ water whose thermal phase change is at 0 °C.The coolant is in a sealed pouch housed inside anotherbag, i.e., in a double bag in order to provide better protection. The most efficient cooling is achieved when the coolant pouch is in direct contact with the blood or platelet pack. However, the most important point is that the efficiency of the coolant depends on the insulating capacity of the blood transport box. The coolant is reusable and therefore cost-effective and eliminates the need for ice and water which can be messy.
- Transportation of platelet concentrate: Platelet components must be continuously agitated and the platelet components should not be used if agitation has not occurred for more than 24 hours. This means that transportation of these components cannot take longer than 24 hours from the time the product leaves the blood supplier. All efforts must be made to ensure that platelets (and granulocyte) concentrates are maintained at room temperature i.e. between 20- 24°C during transportation. A well-insulated container without added ice is often sufficient. If the ambient temperature is high and the distance is great transportation should be done with special coolant pouches that will maintain a temperature around 20°-24°C.
- Transportation of frozen blood components: As FYIII and FV are heat labile coagulation factors, fresh frozen plasma meant to supplement FYIII and F’) levels in a patient with bleeding manifestation has to be stored and transported at 30°C or lower. Fresh frozen plasma or frozen plasma should be transported in light temperature proof containers with plenty of ice packs and should be placed in cardboard boxes to prevent the adjacent bags from getting frozen on the surface of the other bag.
- Examining Blood Units After Transportation: On receiving the blood units, these should be grossly checked for any sign of deterioration or haemolysis either due to wide temperature variation or due to bacterial infection.
Usually you need to look for any
- Leakage or breakage
- any change in color of plasm
- change in color of red cell
- any clots or abnormal mass
- any foul smell
- any change in interface between cell and plasma as a fuzzy interface suggest haemolysis
- Records that maintain the chain of traceability must be kept so that it is possible to trace all blood components from their source to final destination.
-Reference:
Blood Transportation - Simple Basics
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