Operating Room Blood Delivery Turnaround Time

To the Editor.—The Q-Probe summary of operating room blood delivery turnaround time,1 which is of general interest and may be used by hospital blood banks/transfusion services for process improvement activities, provides an opportunity to comment on the confusion we create from using inexact terminology. As a profession, we have been less than rigorous in applying strict terminology to our practices—just look at the designations we use for platelets—and this article provides an opportunity to comment on the unfortunate misuse of a single term, “release.” The word release was used throughout this article to mean “issue or dispense.”In the field of transfusion medicine, the word release has unfortunately been (mis)used to describe at least 4 distinctly different actions related to blood components and blood transfusion. Blood collecting organizations release blood components to be delivered (distributed, in Food and Drug Administration terminology) to hospitals for patient use, once all data (from donor histories, donor records, testing results, etc) have been received and are acceptable. Transfusion services release crossmatched units that are unused for an identified patient within a specified time interval, to be returned to general inventory for future use by any patient. Transfusion services also, as stated in this article, release crossmatched or otherwise patient-specific components from the blood bank to the patient in the operating room. (A fourth misuse—related to the third—is the emergency release of uncrossmatched units for use by a specific patient.) Both of these latter events are more properly termed “issuance” or, as a colleague has recently suggested because of the analogy to medications, “dispensing” of blood components.Let's start cleaning up our verbiage. Here's a suggestion for standardizing terminology. From the time a blood component is collected until all required testing/evaluations are complete, it is held in quarantine. Once all required information is received and the unit can be labeled, it is released from quarantine to complete the labeling/other steps. When blood components are labeled and fully eligible for individual patient use, the collection site distributes them to transfusion services. When transfusion services respond to a request for a specific patient's needs, they issue or dispense the appropriate component (emergent or not). When a previously crossmatched or otherwise reserved (e.g., eligible autologous or directed) blood component is no longer needed by the specified patient, the component is released back into general inventory for any patient who may need it. (This term can also be used when a unit is placed into quarantine for whatever reason, then is deemed eligible for use—it may be released for further action.)Stated another way:Release = action to move a blood component from a restricted (by quarantine, crossmatch, designation, etc.) to an unrestricted (available for any patient) state.Distribution = delivery of blood components from collection to transfusion site.Issuance/dispensing = transfer of a blood component from the blood bank to a specific patient.This may appear to be a minor point, but perhaps it can be used to initiate an overall improvement in the language of transfusion medicine.