Expiration date on blood for transfusion

[cthomas]

Do you think the blood is as effective nearer the expiration date as it is farther from the expiration date?

Chris

[Zoe's Life]

Chris,

I haven't had to have a transfusion yet (came close, but rebounded quickly with Aranesp), but I have heard many people say fresh blood is much better and reduces their transfusion frequency. Maybe someone with more transfusion frequency will answer also.

FWIW,
Zoe

[Tom M]

I think that the newer the blood the better, since a red blood cell has a life expectancy of about 100 days. I have had many transfusions, but have never really done a comparison or expiration dates and transfusion frequency, I guess because my counts changed so quickly, from one week to the next, it seemed a mute point. I am sure someone on this site has the answer.

[Jbsx19]

Hey Chris,

http://www.americasblood.org/go.cfm?do=Page.View&pid=12 Here's a link to some great facts for you on blood. Hope this helps.

Hang in there,
Judi

[Valerie]

Chris,
Never dreaming people in our position would EVER be given expired blood, I just recently started checking the dates of the blood I'm receiving. Decided to check because the last few txs have been ineffective and given me no color as previous ones had. I just received txs # 19 and 20. At #18 the blood expired that very day. # 19 expired the day before it was given to me. I have had no luck getting any answers regarding this from anyone in the medical field. I have also had no luck researching the internet. This does not seem right to me at all as my txs are to keep me alive, not tie me over from blood loss / surgery etc until my own marrow takes over once again. I am extremely concerned over this but no one seems to want to talk about it, including my doctor.

The shelf life of red blood cells is roughly 35-42 days. Fresher blood it would seem would have many more immature cells which would mature for your usage.

I have a feeling this may be common practice but we are not usually checking the expiration dates. Who would ever expect to be getting stale blood !

Sincerely,
Valerie
MDS 5q- since 1993
20 transfusions
Aranesp 500 mcg every other week- doubt it's helping

[Wendy Beltrami]

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

[Valerie]

Hi Wendy,
I even took your previous post on this to my
hem/ onc. If the doc's responsibility ends when he orders the transfusion, how do you handle this situation ? I have made the request to the oncologist, the nurses at the infusion center, asked my GP about it ( and of course it's now out of his hands ) and asked the NP who ordered the last tx to request fresh blood. I know she did it because at the time of the tx when they brought the expired blood and were matching the bag to my arm band, they did not read aloud the expiration date and that immediately alerted me. SO I climbed up and read it myself!

Who is responsible for seeing that we people get the fresh stuff- who can you complain to, beg and try and get the fresh blood ? Anything I have found on this says it's totally done as a courtesy by the blood bank if it does not intefere with their inventory procedures. Everyone tries to blame it on the blood bank but how do you reach them ? When I asked my oncologist what you have to do to get fresh blood he looked at me funny and I'm guessing very truthfully said " know someone ". Well I don't know anyone !

I am B+ which I know is not the most common and they give me both B+ and B-, sometimes both the same and sometimes one of each. I know you contacted someone to order the freshest ahead of time, but I'm pretty much advocating for myself and they already hate to see me coming because my veins are so tiny and I request the best nurse. Then I even tried taking them baked brownies smothered in chocolate frosting and nuts but even that hasn't worked : )

I don't think the blood bank, doctors or anyone involved really believe it makes a difference and I can't find a darn thing on the subject other than your posts to back up my belief that this does make a huge difference. I am convinced by the way I feel. I would barely have known I had these last 4 transfusions.

I see the doctor next week and would like to somehow be prepared to show him facts and figures- not just my say so which results in them just thinking I'm being a thorn in their backside.

Have you ever found anything in writing to back us up ?

Thanks, Wendy, and anyone else who might be able to provide assisance.

Valerie MDS- 1993

[Wendy Beltrami]

Hi Valerie-
I wish I could tell you that I had something to back it up in writing. I don't. I only have direct experience with Grant's transfusions. I have always charted everything and there is a definite difference we notice with fresh and type specific platelets. We have not noticed any difference between rh positive and rh negative. We have also noticed a difference in prbcs when they are expiring within the week or within 3-4 weeks.

I THINK it was Melissa Rhodes, MD from Vanderbilt in Nashville that told me they always prioritize super fresh blood for their babies and that it does make a difference for them.

Am I crazy or isn't this just common sense? ESPECIALLY with platelets since their life span is so short. Just for argument's sake, let's say that every single platelet in a particular unit is brand new and has 7 full days of life remaining after bacterial quarantine and will remain bacteria free for 7 days. Wouldn't you want those platelets instead of a bag that was expiring the same day?
And obviously, when platelets are collected, they are all in varying stages of their lifespan so a unit would never be 100% fresh platelets anyhow. Some are brand new and some are just about to die so even in the best case scenario, maybe 15% (?) of a unit is brand new super fresh platelets- what do you think? I'm just guessing here.

After the last conference, I asked Marilyn Baker to see if someone could come from a Blood Bank center and talk about this at this year's conference. I wonder if anything ever came of that? She seemed very motivated to follow up on that, based on the panel's response to my questions last year.

As for "knowing someone" in blood bank..., I just flat out refuse the unit if it's old. I tell them that I was not going to accept a product where I didn't believe the benefit for my child outweighed the usual risk of transfusion. Especially now that he has iron overload, why would I give him blood that was adding to his iron overload but not giving him the benefit of the good hemoglobin he needed. I had the support of his doctor as well whose orders always specify "as fresh as possible". Obviously, when they are trying to give you products that are expiring that day, they are not as fresh as possible. I remember once when our hospital blood bank ordered a unit of platelets and told them that we wanted ones that were super fresh (meaning at least 2 days from expiration) the blood center on the other end balked a bit. When the blood bank here said that it was for someone whose platelet level was 4K, then they said "OH, alright". Seriously, I don't think the whole "picture" makes it down the pipeline to the blood bank. All they know is that a unit of O negative is being requested. Unless you make a big issue of it, I don't think they get the information about the patient being transfusion dependent. After all, if you are given products that don't give you an extended boost then you are back all the sooner depleting their supply of blood. We're frequent flyers and should be recognized as such.

Wendy/mom to Grant

[skoopman]

I also tracked blood type, size of unit (they are not all exactly the same size), CMV status and expiration date of all of Michelle's transfusions. I also noticed a correlation between freshness of blood product and boost received from it.

Suzanne

[John R]

I had my fourth tx this past Monday, I've had them about every 2 weeks. This time both bags didn't expire for 37 days. Previous tx's had bags that expired anywhere from 2 days to 2 weeks. I won't know for another week or two if the further out expiration date will decrease my frequency of needing tx's.
I asked my doctor about this expiration issue after I read this thread. My Hemonc said he would call the blood bank and ask them to give me the freshest blood available. He also wrote this request on the Dr's. orders which I take with me to the hospital when I am transfused.

John R. MDS-RCMD low in all lines 8/27/07 visit to SCCA for treatment options. Age 46 dxed 12/2002

[cthomas]

John R.,

I think your doctor's response is the only one we should all hear from our doctors anytime we think we have a problem with the system. He's a keeper.

Chris

[Neil Cuadra]

These questions about blood expiration were on my mind as I attended the AA&MDSIF Patient Conference in Las Vegas last week. As Wendy points out, having transfused blood last as long as possible is much more important for those getting regular transfusions than for those needing a single unit, e.g., after surgery, so this question is particular to those with marrow problems.

For that reason, I brought up the issue with Dr. Steven Gore, one of the conference speakers. He's an MDS and leukemia specialist who works at the Sidney Kimmel Cancer Center at Johns Hopkins.

Dr. Gore told me that as long as blood has not reached its expiration date, it should be equally effective when transfused no matter how long since it was donated. He said the reason is that the blood is maintained and preserved while in the blood bank and doesn't deteriorate as it would in the body.

I believe what he was telling me is that the expiration date they assign represents when the blood might first start to become less effective, not the date it becomes ineffective. He said the time period for blood to stay in the bank is set conservatively, i.e., they tend to set expiration dates on the early side.

I also talked to a patient who had monitored blood expiration dates and found no difference in the time between transfusions based on the date of the donated blood.

At least in Dr. Gore's view, patients shouldn't worry about blood freshness. That doesn't mesh with Wendy's experience with Grant's transfusions. So we have one expert's opinion, plus anecdotal evidence supporting both views.

Whether or not we conclude that patients should ask blood banks about their policies and doctors about their transfusion orders, it seems sensible to notice the expiration dates on blood that comes from the blood bank. At a minimum, you certainly don't want blood that has reached the expiration date.

[Wendy Beltrami]

Thanks Neil- Interesting comments from Dr. Gore. I wonder if he was just referring to red blood cells which are refrigerated. Platelets are NOT refrigerated so I question what it is that the blood banks do to "maintain and preserve" a platelet that has only a 10 day life cycle in the first place.

I still think this is a topic that AAMDSIF should be including with the next conference agenda and will continue to advocate for Grant to get the freshest product available.

Wendy/mom to Grant

[Margie]

I receive two units of Packed red cells every 3-4 weeks. During the last transfusion, for some reason, I decided to read the label on the first unit, then the second. I was being given blood that would expire in 7-11 days. I did mental calculations on the number of red cells that might live long enough to help me, and it didn't seem promising. I asked the nurses what the expiration date meant; they said that the blood was thrown away after the expiration date. When I asked my doctor about the percentage of viable cells that might be left at that point in time, he had this blank look and obviously didn't know what I was talking about. He said the expiration date would not make any difference. I didn't pursue the matter. I will always check the expiration dates in the future.

[cthomas]

Why Banked Blood Goes Bad:

http://tinyurl.com/2ylfec

Stored Blood Lacks Nitric Oxide:

http://www.physorg.com/news111083922.html

Please share your opinions with me.

Chris

[Neil Cuadra]

Those are interesting articles, both about the same research.

The researchers at Duke University identified a potential problem, but also its solution. They found that nitric oxide (N.O.) is necessary to make transfused blood effective, but that the N.O. levels in blood start to deplete within hours of its donation. So it's a potential problem even with recently donated blood. Their solution is to add N.O. back to the banked blood before it is transfused. As they point out, this warrants further study.

As for when to transfuse (how low to let a patient's hematocrit go), doctors will continue to have differing opinions.

[Wendy Beltrami]

Wow, thanks Chris for spotting those articles.

It is wonderful that the spotlight is being put upon the quality of the blood supply. It can only mean benefit for all of our transfusion dependent loved ones.
I hope that this will be the prod that is needed for some clinical trials and data gathering.

I still maintain that fresher is better. I wonder if the units referred to in the article were prbcs or actually whole blood?

I would really like to see some scientifically gathered statistics on patients with that are transfusion dependent on platelets AND prbcs.

Wendy/mom to Grant

[Marlene]

Thank you for this post....After reading the info on NO, I googled it to see exactly how NO contributes to overall health. This is from Duke Univ back from 2005. http://www.sciencedaily.com/releases...0527111159.htm

I find this all very interesting on a couple of levels because NO contributes to blood clotting, healthy immunity and most importantly, raises oxygen levels in your tissues. For us, it may explain some complications from iron overload. NO is highly attracted to Iron...it binds to iron and iron proteins rendering the NO inactive. Our organs need oxygen and over time, insufficient oxygen result in organ damage. So it becomes more important to get the excess iron off as soon as possible. Then you have to ask, can you increase NO levels enough to counteract this safely. L-arginine amino acid is key to producing NO. Is supplementation with it warrented in those with high iron as a way to offset the complications of iron overload? Hmmmmm.

John recently found out that his testesterone levels are very low and as well as his Human Growth Hormone. He's currently being assessed to see if it's the pituitary or end organ that's off. Iron overload effects the endocrine system....so you have oxidative damage from the iron and reduced oxygen flow...both which effect the health of organs.

I'm thinking that you really need to boost your anitoxidants alot more than what we have done with iron overload. Most with iron overload are deficient in Vitamin C. So if we correct this, look for way to increase NO and get the iron off, I wonder if these damage organs can repair themselves.

Lots to think about....again...thanks for this post!

Marlene

[Birgitta-A]

Hi all,
Here is an abstract of the effects of routine cold storage and gamma irradiation on the properties of RBC. http://www.sabm.org/news/detail.php?id=579
Kind regards
Birgitta
68 years, dx MDS Intermediate-1 May 2006, transfusion dependent, Desferal, Neupogen and Prednisolone 5 mg/day

[Ruth Cuadra]

Thanks for sharing this, Brigitta.

There is a similar article about the storage duration and white blood cell content of RBC products here:

http://www.ncbi.nlm.nih.gov/sites/en...VAbstractPlus2

Regards,
Ruth

[Birgitta-A]

Hi Ruth,
I think the new facts in the article is that "Gamma irradiation was applied to the sample blood units on day 0, 7, 14, 21 or 28. This resulted, the authors state, in an immediate and drastic and permanent (for the remainder of the storage period) loss of RBC deformability. However, gamma irradiation had no effect on aggregability or adherence." We should try to get blood that hasn´t been stored several weeks and that has been gamma irradiated.
Kind regards
Birgitta

[usaf1125]

I have had 110vunits of Blood. the shelf life is 72 hours. It's just as good then has it was at 1 hr.

[Leigh Ann B]

Originally Posted by cthomas

Do you think the blood is as effective nearer the expiration date as it is farther from the expiration date?

Chris

I believe fresher is better though my mom's onc acts like there is no diff. Mom definitely believes she can tell a difference. She actually heard them say one time "they needed to get rid of some old blood."..... we always look at the expiration date, have never tried to refuse a bag. will try to get the dr to order fresh blood next time but i'm sure that will be a challenge

[Chirley]

I used to think it made a difference but a couple of times I had blood close to expiration and it didn't make any difference to when I needed my next transfusion. In fact one time I went longer than usual between transfusions...go figure!

[Birgitta-A]

Hi All!
For patients that get many txs I think it is important to get as fresh blood as possible. Many studies are done in patients that get txs in connection with for example surgery but these studies are not interesting for us.

Here is a report about fresh blood: http://www.sciencecodex.com/banked_b...y_finds-141049

As I have written before my blood is genotyped and I never get blood that is more than 13 days old for best possible effect.
Kind regards
Birgitta-A
196 units of PRBC since 2006