Canadian Blood Services

Visual Assessment Guide

T05 021 JANUARY 2009 Table of Contents

Introduction 1

How to Use 3

Quick Reference Guide Table 1 - Summary of Visual Appearance 4 Table 2 - Summary of Acceptability Criteria 5

Red Cell Components 6

Platelet Components 12

Plasma Components 18

Cryoprecipitate Components 25

References 26

Acknowledgement 27

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 i Introduction Whole blood donations are collected into a closed bag system that permits aseptic separation into red cells, platelets, plasma and cryoprecipitate. Currently, there are three whole blood processing systems used by the Canadian Blood Services: Buffy Coat (BC) method, Platelet Rich Plasma (PRP) method and Whole Blood (WB) filtration. Platelet and plasma components are also collected by apheresis. Blood components manufactured by Canadian Blood Services are done so under strict manufacturing protocols. INTRODUCTION

Typical Platelet (platelet pool from 4 donors using the buffy coat method)

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 1 This guide has been produced for use by both Canadian Blood Services and hospital personnel.

The acceptability of a blood component for release from Canadian Blood Services is determined by Canadian Blood Services protocols and procedures.

The acceptability of a blood component for transfusion will be determined by local hospital policy and procedures under the direction of the Transfusion Services Medical Director (ref CSA-Z902-04 4.3.6.1). INTRODUCTION

Typical Plasma prepared from whole blood

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 2 How to Use This Visual Assessment Guide This guide is divided into four sections covering the Prolonged exposure to sunlight or fluorescent lighting may four blood components. Each section begins with a cause fading and to maintain the quality of the photographs, brief explanation of the component, a description of the please keep the guide closed when not in use. variations in appearance for that component and criteria for This guide is available on www.transfusionmedicine.ca acceptability. and if it is printed locally or viewed on-line the pictures may Inspection of the blood products should take place in a not be color-true. well-lit area. Coloured products have been photographed Table 1 is a quick guide for conditions that affect the visual against a white background, whereas light-coloured appearance of components. Not all conditions affect all (white) products have been photographed against a dark components. USE TO HOW background to obtain a better viewing contrast. Table 2 is a summary of the acceptability criteria. Visual Assessments Guides printed by the Canadian Blood Services are laminated to increase their durability; however Note: Storage containers may differ in appearance depending the quality of the photographs may decrease over time. on bag vendor. Labels may or may not appear on the back of products and label formats and locations may be different.

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 3 Quick Reference Guide Table 1. Visual appearance of blood components Affected Component Condition Red cells Platelets Plasma Cryoprecipitate

• Loss of intact red cells results in lower hematocrit and a • Red cells present in plasma will • Red cells present in plasma will brighter cherry red color. hemolyze during the freeze/thaw hemolyze during the freeze/thaw Hemolysis • Free hemoglobin imparts a light pink tinge to a dark red n/a process and will impart a pink to process and will impart a pink to almost purple color to the supernatant. red tinge depending on number red tinge depending on number • Occurs as part of normal aging process of red cells involved of red cells involved

• Varies from a light pink / salmon • Varies from a light pink / • Varies from a light pink / Red cell n/a color tinge to a marked red salmon color tinge to a marked salmon color tinge to a marked contamination discoloration red discoloration red discoloration

• A lighter shade of red and an increased opacity of the • Increased opacity • Increased opacity • Increased opacity Lipemia unit similar to a ‘strawberry milkshake’ • ‘Milky’ white appearance • ‘Milky’ white appearance • ‘Milky’ white appearance

Icterus n/a • Bright yellow to brown • Bright yellow to brown • Bright yellow to brown • A dark purple to black discoloration in red cells • Excessive and unusual air • Excessive and unusual air bubbles • Excessive and unusual air • Excessive and unusual air bubbles Bacterial • Clots and fibrin strands bubbles bubbles • Clots and fibrin strands contamination • Increased opacity • Clots and fibrin strands • Clots and fibrin strands • Increased opacity • When assosiated with hemolysis, a pink to red discoloration • Increased opacity • Increased opacity • Grey discoloration may be seen in supernatant.

• Clots and fibrin strands result from • Clots and fibrin strands result from • Clots and fibrin strands result from the activation of the clotting the activation of the clotting the activation of the clotting • Clots appear as small to large dark red or purple masses process and may appear as process and may appears as process and may appears as that do not dissipate with gentle manipulation in red cells. white/opaque masses or whitish white/opaque masses or whitish white/opaque masses or whitish • Cellular aggregates appear as white and opaque masses thread like strands that do not thread like strands that do not thread like strands that do not that do not dissipate with gentle manipulation. Particulate dissipate with gentle manipulation dissipate with gentle manipulation dissipate with gentle manipulation • White particulate matter varies from flattened specks to a matter • Cellular aggregates may appear • Cellular aggregates may appear • Cellular aggregates may appear

greasy film and may dissipate with a change in QUICK REFERENCE GUIDE as white and opaque masses as white and opaque masses as white and opaque masses temperature that do not dissipate with gentle that do not dissipate with gentle that do not dissipate with gentle • Cold agglutinins form large red blood cell masses that do manipulation. manipulation. manipulation. not dissipate with gentle manipulation. • Particulate matter may vary • Particulate matter may vary • Particulate matter may vary considerably in size. considerably in size. considerably in size.

• Pink, red, bright orange / yellow, • Pink, red, bright orange / yellow, • Pink, red, bright orange / yellow, Discoloration • See hemolysis, lipemia, bacterial contamination bright green, or brown bright green, or brown bright green, or brown n/a=Not applicable

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 4 Quick Reference Guide Table 2. Acceptability criteria of blood components Affected Component Condition Red cells Platelets Plasma Cryoprecipitate • Some degree of hemolysis is acceptable • Some degree of hemolysis is possible and expected. The CSA standard will • Some degree of hemolysis is possible Hemolysis n/a depending on the number of red cells depending on the number of red cells defne acceptable levels of hemolysis as in the plasma. in the plasma. < 0.8% at expiry. • Currently there are no standards of acceptability of red cell contamination for • Currently, there are no standards of • Currently, there are no standards Red cell platelet units. However, the AABB standards n/a acceptability for red cell contamination of acceptability for red cell contamination recommend compatibility testing when an of plasma units. contamination of plasma units. apheresis platelet contains more than 2ml of red cells (ref AABB standard 24th ed 5.14.5). • Blood components with lipemia are • Blood components with lipemia are • Blood components with lipemia are • Blood components with lipemia are Lipemia acceptable for transfusion. acceptable for transfusion. acceptable for transfusion. acceptable for transfusion.

• Blood components with icterus are • Blood components with icterus are • Blood components with icterus are • Blood components with icterus are Icterus acceptable for transfusion. acceptable for transfusion. acceptable for transfusion. acceptable for transfusion.

• Canadian Blood Services routinely tests • Bacterially contaminated blood platelets derived from whole blood or • Bacterially contaminated blood • Bacterially contaminated blood Bacterial components are not acceptable for apheresis for bacterial contamination. components are not acceptable for components are not acceptable for contamination transfusion Bacterially contaminated blood components transfusion transfusion are not acceptable for transfusion. • Clots and fbrin - Blood components containing clots and / or fbrin strands • Clots and fbrin - Blood components • Clots and fbrin - Blood components should not be transfused. containing clots and / or fbrin strands containing clots and / or fbrin • Cellular aggregates - Blood components should not be transfused. strands should not be transfused. • Clots and fbrin Strands - Blood components containing cellular aggregates should not • Cellular Aggregates - Blood • Cellular Aggregates - Blood containing clots and/or fbrin strands should be transfused. components containing cellular components containing cellular Particulate not be transfused. • White Particulate Matter (WPM). Blood aggregates should not be transfused. aggregates should not be transfused. matter • Cellular aggregates- Blood components components containing WPM are • White Particulate Matter (WPM) - WPM • White Particulate Matter (WPM) - containing cellular aggregates should not be acceptable for transfusion. WPM may may be seen in thawed plasma that WPM may be seen in thawed plasma QUICK REFERENCE GUIDE transfused. dissipate with a change in temperature. has been stored in the fridge. Blood that has been stored in the fridge. • Cold agglutinins - Blood components components containing WPM are Blood components containing WPM containing cold agglutinin masses should acceptable for transfusion are acceptable for transfusion not be transfused.

• Discoloration due to icterus (yellow), • Discoloration due to icterus (yellow), • Discoloration due to icterus (yellow), • See hemolysis, lipemia, bacterial oral contraceptives (green), vitamin A or oral contraceptives (green), vitamin A oral contraceptives (green), vitamin A Discoloration contamination large quantities of carrots (orange) are all or large quantities of carrots (orange) or large quantities of carrots (orange) acceptable for transfusion. are all acceptable for transfusion. are all acceptable for transfusion. n/a=Not applicable

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 5 Red Cell Components

Red Cell Units Red cell units are an even suspension of red cells in a small amount of residual plasma and additive solution. The visual appearance of segments should not be used to assess a red cell unit as they may not reflect the content of the bag.6 Units should be allowed to settle to permit an assessment of the supernatant. There is a normal variation in the shade of red seen in red cell units that may reflect a difference in the hematocrit of the donor (i.e. a higher hematocrit

will result in a darker red). RED COMPONENTS CELL

Typical Red Blood Cells prepared from whole blood

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 6 Appearance of Red Cell Units • Visual assessment of supernatant color is the only There are several conditions that may change the non-destructive means to estimate hemolysis in a red appearance of the red cell unit: cell unit. It is very subjective and it is difficult to define a “cut-off” color for determining a unit’s acceptability. Hemolysis The color of the supernatant varies according to the volume of the supernatant and the hematocrit and • Visual appearance hemoglobin levels in the red cell unit. – Of particular note, hemolysis caused by bacterial contamination may result in a dark purple to black The presence of red cells in the supernatant may be discoloration (see ‘Bacterial Contamination’). mistaken for hemolysis. If hemolysis is suspected, it – Free hemoglobin within the supernatant of red may be worthwhile to allow the unit to settle for 24 cells will cause a discoloration that will vary from hours or more to minimize red cell contamination of the a light pink tinge to a dark red almost purple supernatant prior to inspection for hemolysis. color, depending on the extent of hemolysis (i.e. a • There are numerous causes of hemolysis. A few higher degree of hemolysis will result in a darker examples related to the manufacturing process and discoloration). subsequent handling of red cell units are: • Hemolysis is the break down of red cells and the – Temperature extremes subsequent release of hemoglobin, the pigmented – Excessive centrifugation protein in red cells. Hemolysis of stored red cells is – Tubing stripping

a normal process and increases with storage times. – Tubing heat sealers RED COMPONENTS CELL Some degree of hemolysis is acceptable and expected. – Sheer force during manufacturing eg. kinked The CSA standard will defne acceptable levels of tubing, improperly broken cannula hemolysis as < 0.8% at expiry. – Bacterial contamination – Mishandling – Incompatible solutions

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 7 Supernatant of RBC Supernatant of RBC Supernatant of RBC showing Percent Hemolysis = 0.11 % Percent Hemolysis = 0.36 % higher levels of hemolysis Percent Hemolysis = 1.14 % RED COMPONENTS CELL

Photographs were taken after allowing the RBC to settle for 4 days to permit an evident visualization of the supernatant. This assessment may be performed earlier or later. The CSA standard will defne acceptable levels of hemolysis as < 0.8% at expiry.

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 8 Lipemia – The presence of bacteria may activate clotting resulting in clots and fibrin • Visual appearance strands. Bacterial – The appearance of a lipemic red Lipemic RBC Unit Contamination in No picture available – Increased opacity RBC Unit cell unit has been compared to a at this time No picture available – Because bacterial contamination at this time ‘strawberry milkshake’. can cause hemolysis, a pink to red • Lipemia is the presence of lipid particles in the blood. discoloration may be seen in the The presence of lipemia is acceptable for transfusion. supernatant. When excessive lipemia interferes with testing all • Bacterial contamination is the presence of bacteria in the components are discarded at Canadian Blood Services. blood. Blood should be free of bacteria. Blood donations • Causes of lipemia in a red cell unit are donor related and are collected and then processed in a closed system to may be related to: maintain aseptic conditions. – Fatty meals before blood donation Bacterially contaminated blood components are not – Chronic conditions such as hypercholesterolemia acceptable for transfusion. Bacterial contamination • Bacterial contamination may be related to the donor or subsequent manufacturing processes. • Visual appearance – There are usually no visible changes – Donor with asymptomatic bacteremia (i.e. bacteria to the component, but occasionally it may be possible to in blood) detect the following:

– Inadequate cleansing of skin prior to venipuncture. RED COMPONENTS CELL – Growing bacteria within a red cell unit may To minimize bacterial contamination, CBS uses a consume the oxygen and cause a dark purple to diversion pouch for the first portion of the blood black discoloration in red cells. donation that should capture the skin plug. – The presence of bacteria may produce gas – Loss of sterility during component manufacturing or resulting in excessive and unusual air bubbles. handling.

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 9 Particulate matter • Particulate matter, as opposed to foreign objects, can be the result of blood collection and / or component Clot in RBC unit manufacturing processes. Composed of platelets, white and red blood cells, and / or in some instances fibrin, particulate matter may increase during storage of a red cell unit. There are several categories of particulate matter that may be found within in a red cell unit:

1. Clots and fibrin strands – Clots and fibrin strands result from the activation of the clotting processes and can be a mixture of clotting proteins (including fibrin) and platelets. Blood donations are collected and processed in bags that contain anticoagulants to inhibit the clotting processes. Blood components containing clots and / or fibrin strands should not be transfused.

– Clots may appear as small to large dark red or RED COMPONENTS CELL purple masses that do not dissipate with gentle manipulation in red cells.

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 10 2. Cellular aggregates – Cellular aggregates may appear as white and opaque masses that do not dissipate with gentle manipulation. Blood components containing cellular aggregates should not be White transfused. Particulate Matter in RBC unit 3. White particulate matter (WPM) – WPM is a non-cellular material and is a normal constituent of blood. The WPM may dissipate with a change in temperature. – WPM is a lipid-rich material that appears white in color and variable in shape, from flattened specks to a greasy film. Generally there are low numbers of WPM per red cell unit. – The presence of WPM is acceptable for transfusion.

4. Cold agglutinins form large red blood cell masses RED COMPONENTS CELL that do not dissipate with gentle manipulation. Blood components containing cold agglutinin masses should not be transfused.

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 11 White Particulate Matter in RBC unit RED COMPONENTS CELL

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 12 Platelet Components

Platelet Units

There are three current methods of platelet production: Pooled Platelets from BC production, Random Donor Platelet units from PRP production methods, and Apheresis Platelets (AP).

Because platelet units contain cells and plasma, they are opaque and vary in color from beige to yellow. Residual red cells in platelet units may confer a salmon / pink or marked red colouring. PLATELET COMPONENTS PLATELET

Typical Platelet (platelet pool from 4 donors using the buffy coat method)

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 13 PLATELET COMPONENTS PLATELET

Typical Platelet (prepared Typical Platelet using the PRP method) (prepared by Apheresis)

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 14 Appearance of Platelets Units There are several conditions that may change the appearance of platelet units:

Red cell contamination • Visual appearance – The degree of red discoloration reflects the amount of red cell contamination and this varies from a light pink / salmon color tinge to a marked red discoloration. • Red cell contamination occurs during production and results from ineffective separation of red cells and platelets. Currently there are no standards of acceptability of red cell contamination for platelet units. However, the AABB standards recommend compatability testing when an apheresis platelet contains more than 2 ml of red cells. (ref AABB standard 24th ed 5.14.5) PLATELET COMPONENTS PLATELET

Red Cell Contamination in Pooled Platelet Unit (platelets prepared using the Buffy Coat method) RBC contamination = 2.15 mL RBC.

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 15 Lipemia

• Visual appearance Refer to – Lipemia may result in a ‘milky’ plasma white appearance. components for photographs • Lipemia is the presence of lipid particles in the blood. The presence of lipemia is acceptable for transfusion. When excessive lipemia interferes with testing all components are discarded at Canadian Blood Services. • Causes of lipemia in a platelet unit are donor related and may be related to: – Fatty meals before blood donation – Chronic conditions such as hypercholesterolemia Icterus • Visual appearance – Bright yellow to brown.

• Icterus, describes the yellow discoloration due to high COMPONENTS PLATELET bilirubin content in blood. The presence of icterus is acceptable for transfusion.

Red Cell Contamination in Platelets (platelets prepared using the PRP method) RBC contamination = 0.50 mL RBC

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 16 When excessive bilirubin interferes with testing all Bacterially contaminated blood components are not components are discarded at Canadian Blood Services. acceptable for transfusion. • Causes of icterus in a platelet unit from eligible donors • Bacterial contamination may be related to the donor or may be related to: subsequent manufacturing processes. – Inherited liver disorders (e.g. Gilbert’s Syndrome) – Donor with asymptomatic bacteremia (i.e. bacteria in – Gallstones blood) – Inadequate cleansing of skin prior to venipuncture. Bacterial contamination To minimize bacterial contamination, CBS uses a • Visual appearance - There are usually diversion pouch for the first portion of the blood no visible changes to the component, donation that should capture the skin plug. Bacterial but occasionally it may be possible to contamination in – Loss of sterility during component manufacturing or Platelet unit detect the following: No picture available handling. – The presence of bacteria may at this time Particulate matter produce gas resulting in excessive and unusual air bubbles. • Visual appearance – The presence of bacteria may activate clotting – Clots may appear as white and opaque masses that do resulting in clots and fibrin strands. not dissipate with gentle manipulation. – Increased opacity • Particulate matter, as opposed to foreign objects, can be the – Grey discoloration

result of blood collection and / or component manufacturing COMPONENTS PLATELET • Bacterial contamination is the presence of bacteria in the processes. There are several categories of particulate blood. Blood should be free of bacteria. Blood donations matter that may be found within in a platelet unit: are collected and then processed in a closed system to 1. Clots and fibrin strands maintain aseptic conditions. Canadian Blood Services – Clots and fibrin strands result from the activation routinely tests platelets derived from whole blood or of the clotting processes and can be a mixture aphereses for bacterial contamination.

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 17 of clotting proteins, platelets and fibrin. Blood Discoloration donations are collected and processed in bags • The term ‘discoloration’ refers to a variety of donor factors that that contain anticoagulants to inhibit the clotting alter the plasma portion of platelet units and these can range processes. Blood components containing clots from metabolic conditions to medications or large doses of and fibrin strands should not be transfused. vitamins taken by donors. Discoloration from contamination 2. Cellular aggregates with red cells or bacteria, can also be causes. – Cellular aggregates may appear as white and • Causes of discoloration, and their resulting alterations of plasma opaque masses that do not dissipate with gentle color, include: manipulation. Blood components containing – Contamination cellular aggregates should not be transfused. 1. Red cell – see section 1, Platelet Components. 2. Bacterial – see section 4, Platelet Components. Bacterially contaminated blood components are not acceptable for transfusion. – bright yellow to greenish brown – Icterus. Acceptable for transfusion. – light green – Oral contraceptive pill. Acceptable for transfusion. – bright orange – Vitamin A and large quantities of carrots.

Acceptable for transfusion. COMPONENTS PLATELET

Particulate Matter in Platelet Unit (platelets prepared using the PRP method

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 18 Plasma Components

Plasma Units Currently there are four plasma components produced: Plasma, Frozen Plasma, Fresh Frozen Plasma, and Cryosupernatant Plasma. PLASMA COMPONENTS

Typical Apheresis Fresh Frozen Plasma

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 19 CANADIAN BLOOD SERVICES Examples of aTypical Plasmaprepared fromwholeblood T05 021 JANUARY 2009 20

PLASMA COMPONENTS Appearance of Plasma Units There are several conditions that may change the appearance of plasma units:

Red cell contamination

• Red cell contamination occurs during production and results from ineffective separation of red cells and plasma.

• Plasma unit – The degree of red discoloration reflects the amount of red cell contamination and this varies from a light pink / salmon color tinge to a marked red discoloration. – Currently, there are no standards of acceptability for red cell contamination of plasma units.

Lipemia

• Visual appearance PLASMA COMPONENTS – Lipemia may result in a ‘milky’ white appearance.

• Lipemia is the presence of lipid particles in the blood.

The presence of lipemia is acceptable for transfusion.

Lipemic Plasma

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 21 When excessive lipemia interferes with testing all components are discarded at Canadian Blood Services.

• Causes of lipemia in a plasma unit are donor related and may be related to: – Fatty meals before blood donation – Chronic conditions such as hypercholesterolemia

Icterus

• Visual appearance – Bright yellow to brown.

• Icterus, describes the yellow discoloration due to high bilirubin content in blood.

The presence of icterus in a blood component is acceptable for transfusion. When excessive bilirubin interferes with testing all components are discarded at Canadian Blood

Services. PLASMA COMPONENTS

• Causes of icterus in a plasma from eligible donors may be related to: – Inherited liver disorders (e.g. Gilbert’s Syndrome) – Gallstones Icteric Plasma

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 22 Bacterial contamination – Donor with asymptomatic bacteremia (i.e. bacteria in blood) • Visual appearance - There are usually – Inadequate cleansing of skin prior to venipuncture. no visible changes to the component, Bacterial contamination in To minimize bacterial contamination, CBS uses a but occasionally it may be possible to Plasma unit diversion pouch for the first portion of the blood detect the following: No picture available at this time donation that should capture the skin plug. – The presence of bacteria may – Loss of sterility during component manufacturing or produce gas resulting in unusual handling. air bubbles. – The presence of bacteria may activate clotting Particulate matter resulting in clots and fibrin strands. • Visual appearance – Increased opacity. – Particulate matter may appear as white and • Bacterial contamination is the presence of bacteria opaque masses that do not dissipate with gentle in the blood. Blood should be free of bacteria. Blood manipulation. donations are collected and then processed in a closed • Particulate matter, as opposed to foreign objects, can system to maintain aseptic conditions. be the result of blood collection and / or component Bacterially contaminated blood components are not manufacturing processes. Composed of platelets, white PLASMA COMPONENTS acceptable for transfusion. and red blood cells, and / or in some instances fibrin, particulate matter may increase during storage of a • Bacterial contamination may be related to the donor or plasma unit. There are several categories of particulate subsequent manufacturing processes. matter that may be found within in a plasma unit:

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 23 1. Clots and fibrin strands Discoloration – Clots and fibrin strands result from the • The term ‘discoloration’ refers to a variety of donor factors activation of the clotting processes and can be that alter the plasma units and these can range from a mixture of clotting proteins (including fibrin) metabolic conditions to medications or large doses of and platelets. Blood donations are collected and vitamins taken by donors. Discoloration from contamination processed in bags that contain anticoagulants to with red cells and bacteria (see Appearance of Red Cell inhibit the clotting processes. Blood components Units), can also be causes. containing clots and fibrin strands should not be transfused. • Causes of discoloration, and their resulting alterations of plasma color, include: 2. Cellular aggregates – Contamination – Cellular aggregates may appear as white and 1. Red cell – see section 1, Plasma Components. opaque masses that do not dissipate with gentle 2. Bacterial – see section 4, Plasma Components. manipulation. Blood components containing Bacterially contaminated blood components are not cellular aggregates should not be transfused. acceptable for transfusion. 3. White Particulate Matter (WPM) – bright yellow to greenish brown – Icterus. Acceptable – WPM may be seen in thawed plasma that has for transfusion.

been stored in the fridge. Components with – light green – Oral contraceptive pill. Acceptable for PLASMA COMPONENTS WPM are acceptable for transfusion. transfusion. – bright orange – Vitamin A and large quantities of carrots. Acceptable for transfusion.

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 24 PLASMA COMPONENTS

Plasma with Green Colour (green colour is commonly a result of donor taking oral contraceptive pill)

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 25 Cryoprecipitate Components

Cryoprecipitate Units Cryoprecipitate appears as a concentrated precipitate at the bottom of a bag. It will appear thick, opaque, whitish and paste- like. Upon thawing, the cryoprecipitate mass will dissolve and re-suspend in the small amount of residual plasma and appear as an even, thick, whitish liquid.

Appearance of Cryoprecipitate Units There are several conditions that may change the appearance of cryoprecipitate units: The unusual conditions described in the plasma components section may also apply to cryoprecipitate components. CRYOPRECIPITATE COMPONENTS CRYOPRECIPITATE

Examples of a Typical Cryoprecipitate

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 26 References

1. Visual Inspection Reference Guide, American National Red Cross, American Red Cross Biomedical Services, 2006. 2. Standards for Blood Banks and Transfusion Services, 23rd Edition. AABB, 2005. 3. FDA summary basis of approval for red blood cells frozen and red blood cells deglycerolized (Reference number 86-0335). Applicant-Department of the Navy, Navy Hospital, Bethesda, MD, US License Number 635-10 1986. 4. Council of Europe. Guide to the preparation, use and quality assurance of blood components, 9th ed. Strasbourg, France: Council of Europe Publishing, 2003. 5. Investigation of White Particulate Matter Found in Red Cell REFERENCES Concentrates, Devine D, Canadian Blood Services, 2003. 6. Janatpour KA, Paglieroni TG, Crocker VL, et al. Visual assessment of hemolysis in red blood cell units and segments can be deceptive. Transfusion 2004:44:984-989. 7. Houseworth JL, Parks JA, Miguel EA, et al. Iatrogenic green plasma. Transfusion 2005;45:1047. 8. CSA standard, Z 902-04 Blood and Blood components.

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 27 Acknowledgement

Canadian Blood Services extends thanks to those who contributed to the preparation of this guide and to those who provided a peer review.

Dr. Jason Acker Ryan Andress Dr. Maggie Constantine Shelley Doyle Myriam Hurabielle Craig Jenkins Wanda Lefresne Dr. Katherine Serrano Susan Shimla Dr. Tanya Petraszko Janet Unrau Fraser Health Authority, British Columbia Vancouver Island Health Authority, British Columbia Red Deer Regional Hospital, Alberta Canadian Blood Services Staff, BC & Yukon Canadian Blood Services Staff, Edmonton

CANADIAN BLOOD SERVICES T05 021 JANUARY 2009 28