CFR Title 21 Part 211 subpart F requires:
- Written standard operating procedures
- Documentation of deviations and documentation of the reasons for the deviations.
- Identification of major equipment used to prepare a component
- Quarantine of materials that are found to be defective during manufacturing
- Time limits for each phase of the production of the product when applicable
- Protection of the product from microbial contamination
Title 21, Part 606, subpart F lists the standard operating procedure requirements for blood and blood components. Where applicable, the minimum and maximum acceptable values for testing need to be defined. This section requires:
- Identification of the patient and donor specimens
- Investigation of transfusion reactions
- A procedure for storage of blood components
- A procedure for reissue of blood components
- Process that traces a unit from the donor to the final recipient
Sec. 606.100 Standard operating procedures. (Note: The sections that apply to all transfusion services laboratories are highlighted)
(a) In all instances, except clinical investigations, standard operating procedures shall comply with published additional standards in part 640 of this chapter for the products being processed; except that, references in part 640 relating to licenses, licensed establishments and submission of material or data to or approval by the Director, Center for Biologics Evaluation and Research, are not applicable to establishments not subject to licensure under section 351 of the Public Health Service Act.
(b) Written standard operating procedures shall be maintained and shall include all steps to be followed in the collection, processing, compatibility testing, storage, and distribution of blood and blood components for transfusion and further manufacturing purposes. Such procedures shall be available to the personnel for use in the areas where the procedures are performed. The written standard operating procedures shall include, but are not limited to, descriptions of the following, when applicable:
(1) Criteria used to determine donor suitability, including acceptable medical history criteria.
(2) Methods of performing donor qualifying tests and measurements, including minimum and maximum values for a test or procedure when a factor in determining acceptability.
(3) Solutions and methods used to prepare the site of phlebotomy to give maximum assurance of a sterile container of blood.
(4) Method of accurately relating the product(s) to the donor.
(5) Blood collection procedure, including in-process precautions taken to measure accurately the quantity of blood removed from the donor.
(6) Methods of component preparation, including any time restrictions for specific steps in processing.
(7) All tests and repeat tests performed on blood and blood components during manufacturing.
(8) Pretransfusion testing, where applicable, including precautions to be taken to identify accurately the recipient blood samples and crossmatched donor units.
(9) Procedures for investigating adverse donor and recipient reactions.
(10) Storage temperatures and methods of controlling storage temperatures for all blood products and reagents as prescribed in 600.15 and 610.53 of this chapter.
(11) Length of expiration dates, if any, assigned for all final products as prescribed in 610.53 of this chapter.
(12) Criteria for determining whether returned blood is suitable for reissue.
(13) Procedures used for relating a unit of blood or blood component from the donor to its final disposition.
(14) Quality control procedures for supplies and reagents employed in blood collection, processing and pretransfusion testing.
(15) Schedules and procedures for equipment maintenance and calibration.
(16) Labeling procedures, including safeguards to avoid labeling mixups.
(17) Procedures of plasmapheresis, plateletpheresis, and leukapheresis, if performed, including precautions to be taken to ensure reinfusion of a donor's own cells.
(18) Procedures for preparing recovered plasma, if performed, including details of separation, pooling, labeling, storage, and distribution.
(19) Procedures under 610.46, 610.47, and 610.48 of this chapter:
(i) To identify previously donated blood and blood components from a donor who later tests reactive for evidence of human immunodeficiency virus (HIV) infection or hepatitis C virus (HCV) infection when tested under 610.40 of this chapter, or when a blood establishment is made aware of other reliable test results or information indicating evidence of HIV or HCV infection;
(ii) To quarantine in-date blood and blood components previously donated by such a donor that are intended for use in another person or further manufacture into injectable products, except pooled components intended solely for further manufacturing into products that are manufactured using validated viral clearance procedures;
(iii) To notify consignees to quarantine in-date blood and blood components previously donated by such a donor intended for use in another person or for further manufacture into injectable products, except pooled components intended solely for further manufacturing into products that are manufactured using validated viral clearance procedures;
(iv) To determine the suitability for release, destruction, or relabeling of quarantined in-date blood and blood components;
(v) To notify consignees of the results of the HIV or HCV testing performed on the donors of such blood and blood components;
(vi) To notify the transfusion recipient, the recipient's physician of record, or the recipient's legal representative that the recipient received blood or blood components at increased risk of transmitting HIV or HCV, respectively.
(20) Procedures for donor deferral as prescribed in 610.41 of this chapter; and procedures for donor notification and autologous donor referring physician notification, including procedures for the appropriate followup if the initial attempt at notification fails, as prescribed in 630.6 of this chapter.
(c) All records pertinent to the lot or unit maintained pursuant to these regulations shall be reviewed before the release or distribution of a lot or unit of final product. The review or portions of the review may be performed at appropriate periods during or after blood collecting, processing, compatibility testing and storing. A thorough investigation, including the conclusions and followup, of any unexplained discrepancy or the failure of a lot or unit to meet any of its specifications shall be made and recorded.
(d) In addition to the requirements of this subpart and in conformity with this section, any facility may utilize current standard operating procedures such as the manuals of the organizations, as long as such specific procedures are consistent with, and at least as stringent as, the requirements contained in this part.
(1) AABB
(2) American National Red Cross
(3) Other organizations or individual blood banks, subject to approval by the Director, Center for Biologics Evaluation and Research
