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1. Labelling & maintenance of blood bags Disposal of expired blood

2. Introduction Bags should be used as per instructions of the manufacturer Storage & use should follow “first-expiring first-out” principle Inventory records should be kept for traceability (batch or lot used) Prior to venipuncture, a check to ensure that bag is not damaged or contaminated, and that it is appropriate for the intended collection Abnormal moisture/Discoloration suggests a defect (Discard the bag) An investigation should be conducted to evaluate the extent of the problem and appropriate corrective actions should be taken.

3. As soon as bleeding starts, good mixing of blood with anticoagulant solution (to avoid activation of coagulation cascade) After that , bag should be mixed gently. (Continuous automatic mixer or manual mixing every 90 seconds). Collection of 1 unit of whole blood should be done in 12–15 minutes (longer durations may result in activation of coagulation factors)

4. Blood bag Labels Labels tell information about uses, dosage, & administration. They inform the medical staff and ensure proper patient care. Blood Bank Labels clearly identify blood types, antigen testing, cord blood and more Use of different colours is helpful Inventory of donation labels to be strictly controlled (with serial nos.) to avoid mix-ups/ mislabelling due to uncontrolled excess labels

5. Label information Whenever possible, machine-readable labels (barcodes) Identity (group ,volume) & release status Unique donation number (traceability to the donor & all records of manufacturing steps till the final product) Product name (type of component) Required storage conditions Date & time of collection ; & Expiry date ABO and Rh (D) blood group type Autologous blood components : name and unique ID no. of donor & the statement “Autologous donation”. Anticoagulant &/or nutrient/preservative solution in the bag ; its volume

6. Maintenance of blood bags Storage conditions should be controlled & monitored. Staff should know correct storage temperature ranges & alarm settings (Storage temperatures : PRBC 1–6°C ; FFP : minus 25°C or colder; Platelets: 20–24°C) Temperature monitoring and recording system Temperature records (to demonstrate that blood components are stored at the required temperature throughout the storage area) Storage areas for SUPPLY blood should be near an entrance or exit (facilitate dispatch)

7. Prior to distribution, blood components should be visually inspected. Record the person distributing & the person receiving the components Recommended storage conditions must be maintained when blood is moved from one location to another (donation camp to blood bank) Red cell components: Ice should NOT come into direct contact with blood (RBCs freeze and hemolyse ) Special chemical, coolant pouches are available that maintain temperatures of approximately +20 °C to +24 °C (Platelets) Platelets should reach their destination within 24 hours, which is the maximum time allowed without agitation

8. Blood packs should be transported from the collection site to blood bank as soon as possible, time between their collection & component preparation should not be more than 6 hours. If special gel pouches are not available, the blood packs should be transported as quickly as possible at a temperature of +2 °C to +10 °C, but cannot then be used for the preparation of platelet concentrates.

9. Components should be inspected for any signs of deterioration, including: 1. Signs of hemolysis, indicating that the blood has been contaminated, allowed to freeze or become too warm. 2. Any other sign of bacterial contamination (e.g. change of colour in the red cells, which may look darker or purple/black when contaminated) 3. Any clots (blood not mixed properly with anticoagulant when collected) 4. Any leak/Air in the pack 5. Cracks or evidence of thawing (in case of FFP)

10. Return & reissue of Blood If a unit of blood is returned to the blood bank, the following checklist should be used to decide whether it taken in stock or discarded. 1. Unit has been returned to the blood bank within 30 minutes of issue. 2. Verify that the unit has not been opened, by squeezing it gently and looking for blood at the entry port. 3. Check temperature by hand or by folding the unit around a thermometer (Discard if temperature is above 10 ℃ ) 4. After mixing the unit gently , keep it in upright position while it ‘settles out’ in the refrigerator and look for signs of haemolysis or other signs of deterioration (in the plasma and red cells)

11. Disposal of Blood Examples of blood units that must be marked for disposal • Units which have tested positive for infectious agents • Unsuitable products, such as under- and overweight blood packs, or those where the temperature range has not been maintained • Discarded products: e.g. expired units • Blood returned unused but unsuitable for reissue • Blood packs in which leaks have been detected

12. There should be a mechanism in place for reporting wastage of blood so that steps can be taken to prevent its recurrence. Secure and exclusive quarantine storage must be available for blood units awaiting disposal. These units need to be recorded as blood products awaiting disposal Discarded blood components must not be left at room temperature, (store in a designated refrigerator to minimize bacterial growth)

13. Keep discarded products under a security lock to reduce the risk of misuse and prevent access by unauthorized persons When discarding hemolyzed/contaminated components try to establish why this has happened (every step from collection till final preparation)

14. Blood products need to be safely treated and disposed of in an environmentally friendly way Steam sterilization (autoclave) should be the preferred option (+121°C for 20 minutes) When incineration remains the only option, then high temperature pyrolitic incinerators (>1200°C) would be appropriate Blood transfusion bags contain above 50% of polyvinyl chlorine (PVC) incineration at low temperatures generates products of incomplete combustion such as dioxins or furans

15. Disposal via the laboratory sink or underground drains is strongly discouraged Prior disinfection with a chlorine-based solution is must In any case the blood bank drainage system should be connected to the sewerage or to a soakaway pit A minimum distance of 30m must be maintained from existing water sources