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Old Wed Aug 8, 2007, 12:57 PM
Wendy Beltrami Wendy Beltrami is offline
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Join Date: Aug 2006
Posts: 269
Ah! Another of my favorite topics!

Hi Listmates,

I do track the fresh dates and have noticed a difference in transfusion interval when the blood products are close to expiring. Fresher is definitely better. In my son's case- type specific also makes a HUGE difference with prbcs. He is O negative and type A prbcs do NOTHING for him.

I have thrown a hissy fit on more than one occasion when they try to give my son blood or platelets that are not super fresh.

Shelf life on platelets has been 5 days until very recently when it was extended to 7 days. Evidently they found that the additional days for bacterial testing was not necessary(?).. Anyhow, at our hospital, the freshest we are able to get is 2 days from expiration (which now, with the additional 2 days will be 4 days from expiration). So, for example, if Grant were getting platelets today, August 8th, I would want platelets expiring on Aug 12th. They all expire at midnight.

To me, this is simple common sense that transfusion dependent patients get the absolute freshest product available. If most of the platelets are already dead, then that patient is going to be back for another transfusion all that much sooner and put a bigger drain on the supply. Platelets ready to expire, should be used for patients who are needing a one time boost- surgery, an accident, etc. NOT a patient who is not producing adequate supplies of their own. Also, keep in mind that the blood products we all get are irradiated. I cannot find any info on whether irradiating affects a platelets life span but I'm guessing it may(?)

As for prbcs, we are able to get them at nearly a month from expiration. So, for example, if Grant were getting prbcs today, August 8th, I would expect the prbcs to show an expiration date of around Sept 4.

Yes, I HAVE, in fact refused units that were expiring that day or the next day (in the case of platelets) and I HAVE refused prbcs that were expiring in a week or even 2 weeks.

Obviously, if Grant had been in crisis and not been able to wait the extra 3-6 hours for new units or if they simply had not been available for a number of days, we would have been stuck with the "old" units.

If any of you were at the last conference in Nashville, you heard me ask the panel of doctors this very same question about fresh products. I got a very VERY interesting response. One doctor basically told me that he felt it was wrong of me to "waste" the blood unit by refusing it. I told him that I really didn't care and that it was my child I was advocating for. What I didn't have the opportunity to say was that of course the unit wasn't "wasted". It was just returned to the blood bank within minutes and was used for someone else. It became a somewhat controversial subject among the panel and after they took a recess, one of the other doctors sought me out and said that she absolutely agreed with my decision to refuse the stale units. She said that in her hospital, the policy is for the freshest units to go to neonatal ICU and transfusion dependent patients.

SO, I urge you all to actually bring up this topic with your hematologist. My guess is that they give the orders for your transfusions and that's where their involvement ends. The decision about which unit you receive is most likely made by someone in the blood bank and not your doctor. In fact, by the response of doctors on the panel, I wonder if many of them even consider that their patients aren't getting the freshest products available.

Wendy B.
(also known by the blood bank as "that bossy woman who refuses old blood")
mom to Grant age 15 1/2
dx 12/4/98 AA
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