Standard Operating Procedure: Blood Bank Operations

This Standard Operating Procedure (SOP) outlines the rigorous protocols required for the collection, processing, storage, and distribution of blood and blood components. The objective of this document is to ensure the safety, purity, and potency of all blood products, maintaining strict adherence to AABB (Association for the Advancement of Blood & Biotherapies) standards and local regulatory requirements. Failure to follow these steps can result in severe transfusion reactions or death; therefore, precision and double-verification are non-negotiable.

1. Donor Screening and Component Collection

• Verification: Verify donor identity using two forms of government-issued identification.
• Health History Assessment: Conduct the mandatory Uniform Donor History Questionnaire (UDHQ) to identify high-risk behaviors or medical contraindications.
• Physical Examination: Measure temperature (must be ≤ 37.5°C), blood pressure (systolic 90-180 mmHg; diastolic 50-100 mmHg), and hemoglobin levels (≥ 12.5 g/dL for females, ≥ 13.0 g/dL for males).
• Phlebotomy: Utilize aseptic techniques to perform venipuncture. Ensure all collection bags are properly barcoded and matched to the donor ID.

2. Laboratory Testing and Quality Control

• Mandatory Testing: Every unit must undergo infectious disease screening, including HIV (1/2), Hepatitis B/C, Syphilis, and West Nile Virus.
• Blood Grouping: Perform ABO/Rh typing using both forward (cell) and reverse (serum) testing.
• Antibody Screening: Test for clinically significant unexpected antibodies.
• Discrepancy Resolution: If forward and reverse grouping do not match, the unit must be quarantined immediately, and the blood must be re-tested using a different lot of reagents.

3. Storage and Inventory Management

• Whole Blood/RBCs: Maintain temperature between 1°C and 6°C. Monitor refrigerator temperature continuously with an automated alarm system.
• Platelets: Store at room temperature (20°C–24°C) under continuous agitation to maintain viability.
• Fresh Frozen Plasma (FFP): Store at -18°C or colder.
• Inventory Audits: Conduct a physical count of the inventory every 24 hours to ensure that expiration dates are monitored and "First-In, First-Out" (FIFO) protocols are followed.

4. Crossmatching and Issuance

• Sample Validation: Ensure the pre-transfusion sample is labeled with the patient’s full name, medical record number, and date of draw.
• Compatibility Testing: Perform an immediate spin crossmatch (or AHG crossmatch if antibodies are present) between the donor unit and recipient serum.
• Double-Check Verification: Two licensed staff members must verify the patient’s ID against the crossmatch tag and the donor unit label before release.
• Chain of Custody: Document the time of release, name of the courier, and destination ward.

Pro Tips & Pitfalls

• Pro Tip (The "Two-Person" Rule): Regardless of seniority, always perform a mandatory "double-check" on patient blood types and unit labels. Human error in labeling is the leading cause of fatal transfusion reactions.
• Pro Tip (Temperature Mapping): Ensure all storage units have redundant power supplies (UPS/Generator) and that temperature probes are calibrated annually.
• Pitfall (Labeling Errors): Never pre-label collection tubes. Always label tubes at the bedside or chairside immediately after the draw, while the donor is still present.
• Pitfall (Ignoring Alarms): Never silence a refrigerator or freezer alarm without first checking the internal temperature and documenting the cause. Assume the equipment is failing until proven otherwise.

FAQ

Q: What should be done if a blood unit alarm sounds at 3:00 AM? A: Follow the emergency temperature excursion protocol. Assess the unit's actual temperature using a calibrated thermometer. If the temperature is out of range, immediately move the units to a backup validated refrigerator and document the duration of the excursion.

Q: Can I use blood that has been returned to the blood bank? A: Generally, no. Once a unit has left the blood bank and reached a clinical area, it is considered "tainted" due to potential temperature fluctuations. It may only be returned if the blood bank can verify via validated temperature indicators that it never exceeded 10°C during transport.

Q: What is the procedure if a patient has a reaction during transfusion? A: Stop the transfusion immediately. Keep the IV line open with saline. Notify the blood bank and the physician. Return the remaining unit, the attached tubing, and a fresh post-reaction blood sample from the patient to the laboratory for clerical checks and hemolysis investigation.