We report a case of herniation of a 350 ml Terumo Penpol top-and-bottom blood bag system with an integral leukocyte filter for packed red blood cell (PRBC). This blood bag system consists of one primary bag containing citrate-phosphate-dextrose anticoagulant, three transfer bags for plasma, platelet, PRBC, and a SAGM-2 bag. No manufacturing defects or abnormality was found on visual inspection of the bag. The blood donor was screened and bled using an automated Terumo blood collection monitor as per the departmental standard operating procedure.[1]
The blood bag was loaded into the Thermo Cryofuge 6000I centrifuge.[2] After an initial hard spin (3400 RPM for 10 min at 22°C), outpouchings were noticed on the broad surface of the primary bag [Figure 1]. There was no abnormal vibration during centrifugation, and no leakage was noticed from the herniation site. In anticipation of the blood bag rupture, the whole blood in the primary bag was transferred to the plasma bag. The primary bag, the empty PRBC transfer bag, the SAGM 2 bag, and the leukofilter were sealed and discarded. After soft spin (1900 RPM for 6 min at 22°C) centrifugation, PRBC was retained in the plasma bag, and expiry was changed from 42 to 21 days.
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Figure 1: Outpouchings present on the blood bag surface
Improper arrangement of the blood bags into the centrifuge bucket results in uneven distribution of tension, causing pressure build-up in the fragile corners of the bag during hard spin. The blood bag system's platelet and plasma transfer bags are placed first, followed by the SAGM-2 bag and the PRBC transfer bag, over which the leucocyte filter and tubings are placed in order, respectively. Any deviation in this arrangement can cause damage leading to herniation of the blood bag. The ideal manner of loading the blood bag with leukofilters into a refrigerated centrifuge is illustrated in Figure 2.
Figure 2: Illustration of the ideal method of loading top and bottom blood bag system with in-line leukofilter into the refrigerated centrifuge
The method described above is the ideal method which should be followed for loading of the Terumo Penpol top-and-bottom blood bag system with inline leukofilter. However, if Cryofuge is used, which have a larger bucket size, the bags can also be loaded into the same bucket, but care needs to be taken that none of the clamps should be within the folded bags. The clamps should be brought outside and placed on the top of the bags. It also needs to be made sure that the tubings are not entangled.
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Conflicts of interest
There are no conflicts of interest.
References
1. Standards for Blood Banks and Blood Transfusion Services. National AIDS Control Organization, Ministry of Health and Family Welfare. 2007
2. Heraeus Cryofuge 6000i and Cryofuge 8500i Centrifuge Series. Service Manual.
