Temperature monitoring devices
Table 7 summarizes the different devices available to monitor temperatures in blood cold chain equipment. Table 7. Different types of devices available to monitor temperatures usually connected to an electronic device Graduated small bore mercury or alcohol thermometers -10 C to 110 C . Can also be maximum minimum version. Fragile. Either portable with temperature probes and LED temperature display when requested or fixed onto equipment with LED temperature display and visual audible alarm...
Limitations of this Manual
This Manual does not discuss the following specific topics Domestic kitchen type refrigerators or freezers. WHO does not encourage the use of this equipment for the storage of blood and blood components because the design of the equipment does not guarantee the safe storage of blood components. As the compressor is not mechanically isolated from the body of the refrigerator, vibration from the compressor adversely affects red blood cells. In addition, there is no internal cooling fan in the...
The thermostat
The thermostat is a device that senses temperature changes, and at a predetermined temperature activates or deactivates a mechanical or electric activity. Thermostats thus have cut in and cut out set temperatures. These predetermined temperatures may be permanently set in the factory, or may be adjustable by the user. The thermostat starts the compressor when the temperature inside the cabinet rises to a predetermined level, e.g. 5.0 C, and stops it when the temperature inside the cabinet is...
Solar powered blood bank refrigerators
Purpose of Equipment A refrigerator for the storage of whole blood red cell packs in a blood bank Type of Equipment Compression refrigerator which uses CFC-free refrigerant gas and electricity from solar energy Laboratory Test Procedure Standard Test Procedure BTS Proc 5 The hold-over time and cool down times were measured at 43 C ambient at full load. This means that the lower the ambient temperature, the better the performance of the equipment. Solar powered blood bank refrigerators continued...
Walkin cold rooms and freezer rooms
Although there are currently no WHO minimum performance specifications for cold or freezer rooms, the information below is provided for users of this equipment. Walk-in cold and freezer rooms are storage fixtures that are available in a wide variety of sizes to suit every need. They are either permanently erected or of the knockdown type that can be moved. Very large installations are permanent and cannot be moved. Cold and freezer rooms are best constructed at the same time as the blood...
Plasma thawers 1
Specification Reference BTS PT IN.1 Purpose of Equipment To thaw rapidly frozen plasma Type of Equipment At 37 C water bath. Plasma packs held in special containers and constantly agitated uniformly in the bath until thawing is complete. Packs remain dry Laboratory Test Procedure Standard Test Procedure BTS PT.1 Proc. 1 Construction Internal Corrosion resistant material, easy to clean and no staining External Corrosion Resistant CR at least 1mm thickness Design Chest type, lid optional Easy...
Glossary
30 minute rule A general rule in the blood bank stating that a maximum time of 30 minutes is allowed for a blood component issued from the blood bank to a ward to be returned. Ambient temperature atmospheric temperature of the immediate surroundings. Amplitude of the agitation The side-to-side movement of the trays in a platelet agitator. The amplitude is expected to be within the range of 3.6 to 4.0 cm. Available stock Blood components that have been released from quarantine by the quality...
Blood Cold Chain Performance Report
Purpose To report on the status of equipment and blood products in a facility. Responsible The user. However, in a unit where different people are responsible for different equipment, the chief of the facility sends a copy of the form to the local manager. Recipient District manager, unless the user is located in a regional or central office, in which case the reports go to the National Officer. When the report is prepared At the end of every month. How long to keep the report At least 24...
Blood Bank Prefase
The critical contribution that effective management and use of medical equipment brings to health service delivery is only recently gaining recognition. Managing medical equipment has often been misunderstood as the mere procurement of accessible products within a given budget. However, this narrow perspective has proven neither effective, nor cost-effective in the running of health services. The World Health Organization WHO promotes the adoption in countries of a comprehensive life cycle...
Organizing an equipment maintenance programme
The Care and Preventive Maintenance Form should be completed for routine maintenance of the equipment carried out by the blood bank staff. All maintenance and calibration should be recorded, together with any follow-up action taken, since this is part of the quality system. A Repair Record Form should also be developed for whenever the equipment is sent for external maintenance or repair. The forms are straightforward, but are very important tools in the blood cold chain and, indeed, in all...
Whole bood
Whole blood and red cells must always be stored at a temperature between 2 C and 6 C. The main reasons for giving a blood transfusion are to restore or help to maintain the body's oxygen-carrying capacity and the volume of blood circulating around the body. If blood is not stored at between 2 C and 6 C, its oxygen-carrying ability is greatly reduced. The anticoagulant preservative solution in the blood bag contains nutrients for the blood during storage and stops the blood from clotting. The...
Platelet concentrates
Platelet agitator with technician inspecting one of the platelet pools Platelet transfusions are used to prevent spontaneous bleeding or to stop bleeding in patients with established thrombocytopenia or platelet dysfunction e.g. hypoplastic anaemia or bone marrow failure due to replacement with malignant cells or to the effects of chemotherapy. Both manual and automated methods can be used in the preparation of platelet concentrates. Lower temperatures adversely affect platelet function and...
Manual recording of temperatures
It may be necessary to measure temperature manually. If your blood bank refrigerator freezer is not equipped with a continuous recording thermograph, the temperature must be recorded, preferably on a chart or in a record book, along with the date and time it was taken and the position of the thermometer. If the temperature is not between 2 C and 6 C, the possible cause and any action taken should also be recorded and reported. It is a good idea to stick a temperature chart on the front of the...
Useful abbreviations
IEC International Electrotechni-cal Commission ISO International Organization for Standardization VAC voltage alternating current VDC voltage direct current
Alarm systems
Safe blood storage requires that blood components are kept at the appropriate temperature continuously. To achieve this, modern blood bank refrigerators are fitted with different types of alarms, e.g. for temperature, power failure or door-ajar alarms. In the event of power failure, a warning light as well as a continuous sound is generated to alert the user. The warning light ceases when the power supply returns. Even if the blood storage equipment works efficiently, the temperature may often...
Ice packs cooling plates and cooling pouches WHO Specification WHOEPIE5IP1 and
Purpose To be used in combination with transport boxes for the safe movement of blood. Ice Packs those used for transporting vaccines are safe to use for the transport of blood and blood products, with the precaution that they should not come into direct contact with the unit of whole blood or packed red cells. Prefilled ice packs blue ones are not recommended for transporting liquid products because they have a lower freezing point than water, which may lower the temperature of the box too...
Blood transport boxes extended cold life
Purpose of Equipment To carry whole blood from individual donors to blood bank or from blood bank to point of use Laboratory Test Procedure Standard Test Procedure B4 PROC 2 Robustness Fittings 2, casing 2 see ratings in test procedure Net Capacity for Blood Bags 15 to 27 litres approx. 20 bags Cold Life Maintenance of under 10 C for minimum 130 hrs in ambient temperature of 43 C Maximum Ice Melting Rate More than 10 hrs per 1 kg ice melted during 43 C cold life test Cold Packs To conform to...
Ideal design features specific to plasma and cryoprecipitate freezers
Upright plasma freezer with in-built temperature alarms Preset alarm point at -25 C. Compression type plasma freezers are suitable for the storage of plasma FFP and cryoprecipitate. The main difference between a blood refrigerator and a plasma freezer is in the temperatures that they are capable of maintaining. A plasma freezer is expected to operate at a temperature of below -30 C. The equipment should use CFC-free refrigerant gas and electricity supply from the national grid. The freezer has...
The cabinet
The cabinet of the refrigerator or freezer stores the blood packs or plasma packs respectively. Key factors in the design of the cabinet are Blood bank refrigerators are usually of the upright type with glass doors. This is because they are frequently opened to place or retrieve blood packs. It is useful to have the blood packs displayed so that the blood group and date of expiry can be identified without opening the door. Blood bank refrigerators generally have a cooling fan to ensure air...
Developing a training guide
Once SOPs have been developed they become the best tools for training. The SOP can be adapted into a training guide, which serves as a map for both the instructor and the learner. The first step in developing a training guide is to decide upon a standard format that will be used consistently. The following example of a training guide was developed using the SOP which appears in Section 7, Table 16. Table 22. Example of a training guide Task Operate and maintain blood bank refrigerator according...
Issuing blood components to clinical areas
When blood is issued from the blood bank, the time of issue must always be recorded. Blood should be issued in a cold box or insulated carrier which will keep the temperature under 10 C. To avoid wastage, only one unit of red cells should be removed from the blood bank refrigerator at a time unless the rapid transfusion of large quantities of blood is required. It is also recommended that the blood packs are tagged or sealed into the box. A tag that has to be broken by the ward staff before the...
The evaporator
The evaporator is the area that absorbs heat from the cabinet and its contents. The refrigerant gas enters the evaporator as a liquid and absorbs heat and flows out the other end as a vapour. The vapour flows into the condenser under a high pressure from the compressor as the cycle begins again. The evaporator rarely requires repair but needs to be kept clean. The cycle continues until the desired temperature of the cabinet is attained. However, the temperature may rise again due to the limited...
Reviewers included
Dr Noryati Abu Amin, World Health Organization Headquarters, Geneva, Switzerland Dr Rama Bhasin, All India Institute of Medical Sciences, New Delhi, India Professor Kamel Boukef, National Blood Transfusion Centre, Tunis, Tunisia Dr Jose Cruz, World Health Organization Regional Office for the Americas Pan American Health Organization, Washington, D.C., United States of America Dr Graham Harrison, World Health Organization Regional Office for the Western Pacific, Manila, Philippines Mrs Shan...
Unused blood components
Blood and blood products returned to the blood bank must be recorded in the returned to stock or discard register depending on whether the set criteria are met, or not, respectively. This enables the blood bank to trace any problems arising from transfusion of the product or follow up information from the ward about the blood product. The blood returned to stock thus affects the inventory. An unused component should therefore never be discarded at ward or theatre level, even if the patient has...
Flatbed platelet agitators
Specification Reference BTS PA IN.1 Purpose of Equipment To continuously agitate platelet concentrates in a temperature controlled environment at 22 C 5 C in an even suspension in a plasma bag Type of Equipment Flatbed agitator which uses electricity from the national grid Laboratory Test Procedure Standard Test Procedure BTS PA.1 Proc. 1 Construction Open system with no doors and a strong base with handles. Designed to hold a load of 300 ml random or apheresis type platelet packs of up to a...
Disposal or decommissioning of cold chain equipment
Cold chain equipment is removed from routine use permanently in the following situations 1. The equipment fails to maintain desired temperatures. 2. The equipment's technical features no longer meet new standards of safety or performance expected by the laboratory. 3. The equipment is beyond repair, i.e. there are no spare parts available or it is not cost-effective to repair. Such equipment should be removed from the laboratory to a store room for final disposal. It should also be removed from...
Quality indicators for evaluation
Since the purpose of evaluation is to assess the effectiveness of the programme, you need to specify measurable indicators of the extent to which its objectives are being achieved. These can be stated in terms of both ultimate and intermediate outcomes. Table 20. Monitoring and evaluating the blood cold chain BTS or hospital blood bank technicians Relocated products events Per occurrence Returned products as a result of unsuitable transport conditions Discarded products as a result of transport...
Theoretical count
It is possible to calculate the stock on the basis of the available stock, receipts, and the delivery notes of blood issued for use. Similarly, it is possible to calculate the amount of blood accepted in quarantine on the basis of the receipts of donated blood, and that issued from quarantine to available stock. It is thus possible to calculate on a daily or monthly basis the theoretical stock level. However, as the method suggests, it can only be theoretical until a physical count is done of...
Platelet agitators
Platelet concentrates are harvested from whole blood by centrifugation or during platelet apheresis. Platelet concentrates are suspended in about 60 ml of plasma. The packs are continually agitated in a platelet agitator in a room with an ambient temperature of between 20 C and 24 C. This generally requires that the laboratory is air-conditioned in order that the temperatures are maintained within the desired range. The recommended type of agitator is a flatbed agitator with horizontal or...
Cryoprecipitate
Cryoprecipitate is the cold insoluble portion of plasma remaining after FFP has been thawed between 1 C and 6 C and is useful for correct ing certain coagulation defects. It contains approximately 50 of Factor VIII and von Willebrand Factor, 20 40 of fibrinogen and some of the Factor XIII originally present in the fresh plasma. Plasma is separated from red cells within 6 to 8 hours of collecting blood. The plasma is frozen solid rapidly, certainly within 30 minutes of separation from the cells....