What are the guidelines for storing and handling white blood cells (WBCs) or leukocytes for transfusion?

WBC Storage and Handling Guidelines

White blood cells for transfusion must be handled under strict aseptic conditions and transfused within 30 minutes of removal from storage, with the entire transfusion completed within 4 hours to prevent bacterial proliferation and maintain cell viability. 1, 2

Critical Time Parameters

Immediate Handling Requirements

• Start transfusion within 30 minutes of removing WBC products from temperature-controlled storage 1, 2
• Complete the entire transfusion within 4 hours of removal from controlled storage to prevent bacterial growth and hemolysis 1, 3
• The 30-minute window is critical because it minimizes bacterial proliferation risk while maintaining cellular function 2

Storage Before Transfusion

• WBC products prepared for radiolabeling (99mTc-HMPAO) must be processed and reinjected the same day under strict aseptic conditions 4
• Cryopreserved WBCs (for donor WBC infusions in transplant settings) can be stored in liquid nitrogen with 5% DMSO and 6% pentastarch for up to 7 years without loss of viability 5

Mandatory Safety Precautions

Aseptic Technique Requirements

• Use strict aseptic conditions throughout all WBC handling procedures since these products will be reinjected into patients 4
• Wear sterile gloves, cap, and mask during preparation 4
• Perform all procedures in a laminar flow cabinet or cell isolator installed according to local regulations 4
• Use only sterile reagents and disposable plasticware 4

Infection Control Measures

• Wear waterproof gloves throughout the procedure when handling blood components from potentially infected patients 4
• Exercise special caution when handling needles to prevent operator contamination 4
• Use certified sterile closed-kit labeling devices when available for additional protection 4

Cross-Contamination Prevention

• Never label WBCs from multiple patients simultaneously to prevent cross-contamination 4
• Label WBCs from different patients at physically separated locations unless closed devices are used 4
• Clearly label all syringes, tubes, and materials with patient name, bar-code, and/or color code 4
• Verify patient details against bag labels before administration 1

Collection and Processing Guidelines

Blood Collection Parameters

• Use a needle with inner diameter of at least 20 G to prevent WBC damage from shear stress 4
• Collect 51 ml of blood mixed with 9 ml of acid-citrate-dextrose (ACD) anticoagulant 4
• Withdraw blood slowly and smoothly to prevent bubble formation and foaming 4
• Mix by gently turning the syringe end over end—never shake 4

Minimum Cell Requirements

• Require at least 2×10⁸ leucocytes to achieve good labeling efficiency 4
• In neutropenic patients (<2×10³ neutrophils/mm³), collect additional blood volume 4
• Smaller volumes (down to 20 ml) are not recommended as they reduce labeling efficiency 4

Pediatric Considerations

• Draw smaller blood volumes from children based on body weight 4
• Use multiple 10-ml syringes containing 1.8 ml of ACD for pediatric patients 4

Critical Pitfalls to Avoid

Cell Damage Prevention

• Avoid damaging leucocytes during handling, as this causes radioactivity leakage from cells (in labeled products) and reduces viability 4
• Do not use needles smaller than 20 G with large syringes due to high laminar flow causing shear stress 4
• Prevent prolonged exposure to room temperature beyond the 30-minute window 1, 2

Temperature Control

• Maintain strict temperature control throughout storage and handling 1, 2
• The 30-minute rule exists specifically to prevent bacterial proliferation while maintaining cell function 2
• Do not confuse WBC timing with red blood cell protocols (which allow 4 hours for complete transfusion) 1, 2

Product Wastage

• Make every effort to avoid wastage given the limited shelf life and specialized nature of WBC products 1
• Plan transfusion timing carefully to ensure the 30-minute window can be met 2