Blood clot formation in blood bags: Operational evidence, contributing factors, and mitigation strategies in a public blood transfusion service
DOI:
https://doi.org/10.33448/rsd-v15i3.50708Keywords:
Hemotherapy Service, Quality of Health Care, Blood Transfusion, Hemotherapy Units.Abstract
The formation of clots in blood bags represents a critical event for transfusion quality and safety, being associated with operational failures throughout the hemotherapy cycle. Identifying these events requires a systemic approach, considering the interaction between technical, human, and organizational factors involved in the processes of collection, homogenization, and monitoring of blood components. This study aims to analyze clot formation in blood bags within a public blood transfusion service, based on operational and regulatory evidence, identifying contributing factors throughout the blood transfusion cycle and discussing mitigation strategies aimed at strengthening process quality and transfusion safety. This is an observational, retrospective, and documentary study with a quantitative and operational approach, developed from routine records of a public blood transfusion service located in Northeast Brazil, covering the period from January to December 2025. The results demonstrated that clot formation occurred predominantly without exceeding the classic acceptable time and volume limits, indicating that the overall collection time, in isolation, was not a primary determining factor. Clot formation in blood bags should be understood as a systemic event affecting transfusion quality and safety. Preventing these events requires strengthening the standardization of phlebotomy, continuous monitoring of processes, training of teams, and the structured application of root cause analysis, contributing to the reduction of losses, improvement in the quality of blood components, and increased safety of care in public hemotherapy services.
References
AABB. (2024). Standards for blood banks and transfusion services (34th ed.). AABB.
Agência Nacional de Vigilância Sanitária, & Brasil. Ministério da Saúde. (2022). Manual para o Sistema Nacional de Hemovigilância no Brasil: Marco conceitual e operacional. Ministério da Saúde.
Brasil. Ministério da Saúde. (2022). Guia de inspeção visual de hemocomponentes. Ministério da Saúde.
Council of Europe, & European Directorate for the Quality of Medicines & HealthCare. (2023). Guide to the preparation, use and quality assurance of blood components (21st ed.). Council of Europe.
Council of Europe, & European Directorate for the Quality of Medicines & HealthCare. (2025). Guide to the preparation, use and quality assurance of blood components (22nd ed.). Council of Europe.
European Federation of Clinical Chemistry and Laboratory Medicine. (2023). Guideline for venous blood collection (phlebotomy): 3rd revised edition.
Gnanaraj, J., et al. (2022). White thrombus “fibrin” in the blood bag. Asian Journal of Transfusion Science, 16(2), 1–3.
International Organization for Standardization. (2020). ISO 22367:2020: Medical laboratories — Application of risk management to medical laboratories. ISO.
Iqbal, M. S., et al. (2023). Preanalytical errors in a hematology laboratory. Diagnostics, 13(4), 591. https://doi.org/10.3390/diagnostics13040591.
Kani, V., et al. (2024). Preanalytical errors in hematology: Insights from a tertiary care hospital. Cureus.
Kim, H., et al. (2024). In vitro evaluation of DINCH-plasticized blood bags for red blood cell storage with CPDA-1 anticoagulant. Transfusion Medicine and Hemotherapy, 51(4).
Klei, T. R. L., et al. (2023). Recommendations for in vitro evaluation of blood components collected, prepared and stored in non-DEHP medical devices. Vox Sanguinis.
Larsson, L., et al. (2021). Non-phthalate plasticizer DEHT preserves adequate blood component quality during storage in PVC blood bags. Vox Sanguinis, 116, 60–70. https://doi.org/10.1111/vox.13036
Ortiz, J. L. C., et al. (2024). Transfusion-related errors and associated adverse reactions and blood product wastage: Analysis using the NHSN Hemovigilance Module.
Pathak, S., et al. (2021). Blood transfusion set: A possible cause for blood clotting during transfusion? Bali Journal of Anesthesiology, 5(2), 147–148.
Pereira et al. (2018). Metodologia da pesquisa científica. [Free ebook]. Editora da UFSM.
Rajkumar, A., et al. (2024). Clot in the blood bag: A case report. Cureus, 16(9), e69452. https://doi.org/10.7759/cureus.69452
Raturi, M., et al. (2021). Zeroing in on the root cause of the clots in a blood bag: Reinforcing improvement in blood collection practices. Transfusion Clinique et Biologique, 28(3), 303–305. https://doi.org/10.1016/j.tracli.2021.05.004
Risemberg, R. I. C., Wakin, M., & Shitsuka, R. (2026). A importância da metodologia científica no desenvolvimento de artigos científicos. E-Acadêmica, 7(1), e0171675. https://doi.org/10.52076/eacad-v7i1.675.
Shitsuka, R. et al. (2014). Matemática fundamental para tecnologia. (2ed). Editora Érica.
Tran, N. T. L., et al. (2024). Impact of different red blood cell storage solutions and conditions on cell function and viability: A systematic review. Biomolecules, 14(7), 813. https://doi.org/10.3390/biom14070813
World Health Organization. (2022). Blood donor selection: Guidelines on assessing donor suitability for blood donation. WHO.
World Health Organization. (2024). Guidance on implementing a quality system in blood establishments. WHO.
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Copyright (c) 2026 Weber de Santana Teles, Max Cruz da Silva, Florita Moura Aquino, Brenna Loreny Santos Chagas, Mariamália Newton Andrade, Douglas Abilio, Ana Paula Barreto Prata Silva, Ádamo Newton Marinho Andrade, Orleane Souza Rezende, Bruna Medeiros Nóbrega

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