In response to a question about issuing blood products in coolers, Neil shows the care he always gave in replying fully:

Date: Mon, 6 Jul 2015

From: "Blumberg, Neil" <address removed>
To: MEDLAB-L <address removed>
Subject: Re-Issuing Blood Products  

How long are the coolers allowed to remain bedside? 

They are allowed to remain at the patient?s bedside for as long as the patient is unstable so that blood products are readily available if needed.  This is almost always just red cells, almost never FFP or platelets. The Blood Bank technical staff request the cooler be returned after the cooler has been out for approximately 8 hours. If the cooler can't be returned, then the technical staff will change coolants every 8 hours (4 hours if the temperature is approaching 10 C).  We monitor the temperature every 4 hours. OR coolers are considered transport coolers and the acceptable temperature range is 1-10 C. ECMO coolers and salvaged blood coolers are considered storage containers and the acceptable temperature range is 1-6 C.
 
How are they cooled? 

We use coolant packs that have been frozen in our plasma freezer. (colder than -18 C)

Who takes responsibility for returning the units in the coolers to the Blood Bank before the expiration time?

The patient care area. Either a Patient Care Tech or an employee from the transportation department usually returns the coolers to Blood Bank.

Have you had to discard RBC units because they were warm? 

Yes, occasionally.
 
What about thawed plasma and platelets?

These are almost never sent in coolers except as part of massive transfusion protocols. If platelets are returned in a cooler, they are discarded. That said, short exposure to refrigerator temperature is probably not deleterious to platelets. If plasma is returned in a cooler, the product is returned to inventory if the temperature of the cooler was within an acceptable temperature range.
 
Have you had platelets returned in the coolers along with cooled RBC units?

Unfortunately, but occasionally yes. Follow up is performed in each instance  with the patient care area where the cooler was located.

We consider this system far superior to an OR or ED refrigerator where the chance for misadventure is much higher. It also provides the clinical team with some assurance as they get antsy when seriously bleeding patients have to wait for transfusion. Is it occasionally abused? No doubt. But we're here to treat patients, not make life as easy and simple as possible for the Transfusion Service.

Neil Blumberg MD

Professor of Pathology & Laboratory Medicine
Vice-Chair for Laboratory Medicine
Director, Clinical Laboratories
Director, Transfusion Medicine
University of Rochester Medical Center
Rochester NY USA