Asian Journal of Transfusion Science
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Year : 2011  |  Volume : 5  |  Issue : 1  |  Page : 61-62
Visual detection of hemolysis in a blood bag before issue

1 Senior Consultant, Department of Transfusion Medicine, Tata Medical Center, Kolkata, India
2 Consultant, Rotary Bangalore ttk Blood bank, Bangalore, India

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Date of Web Publication21-Jan-2011

How to cite this article:
Choudhury N, Mathur A. Visual detection of hemolysis in a blood bag before issue. Asian J Transfus Sci 2011;5:61-2

How to cite this URL:
Choudhury N, Mathur A. Visual detection of hemolysis in a blood bag before issue. Asian J Transfus Sci [serial online] 2011 [cited 2023 Mar 31];5:61-2. Available from:

   Introduction Top

Hemolysis may occur in a red blood cell (RBC) unit during blood collection, transportation, preservation and or different stages of handling in the blood bank. Visual detection of hemolysis of a unit is possible usually by observing the color of the supernatant plasma. It is a good practice to observe the color of the plasma just before issue to avoid any inadvertent serious transfusion of a hemolysed blood unit. However, practically it is difficult once the stationary blood unit is disturbed or there is no time to centrifuge every unit of cross-matched blood to observe the plasma color.

   Observation Top

It is highly recommended to keep segments on the side of every blood unit for cross-match and further use. The plasma level of the blood unit may be disturbed during routine handling but the separated plasma level in the segment is not disturbed. When a blood unit is hemolysed due to any reason like thermal injury, blood in the bag and also the segment is lysed. Because the plasma is not disturbed in the segments, hemolysis of the unit can be easily observed just before issue. The illustration showed clear color differences between the plasma color in segments of hemolysed and normal blood units [Figure 1].
Figure 1 :Colour of plasma in the segments

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   Pathophysiology of the event Top

The elements of "red blood cell storage lesion" include: morphological changes, slowed metabolism with a decrease in the concentration of adenosine triphosphate (ATP), acidosis with a decrease in the concentration of 2,3-diphosphoglycerate (2,3-DPG), loss of function (usually transient) of cation pumps. There is consequent loss of intracellular potassium and accumulation of sodium within the cytoplasm, oxidative damage with changes to the structure of Band 3 and lipid peroxidation, and loss of parts of the membrane through vesiculation. Together, these events risk compromising the safety and efficacy of long-stored red blood cells, reducing their capacity to carry and release oxygen, promoting the release of potentially toxic intermediates like, free hemoglobin which act as a source of reactive oxygen species. [1],[2]

Hemolysis during blood collection and storage is the most severe manifestation of the red blood cell (RBC) storage lesion. It represents either the rupture of RBCs with the release of hemoglobin (Hb) directly into the suspending fluid or the loss of membrane-bound Hb in microvesicles. [1]

   Preventive measure Top

To prevent these untoward consequences of hemolysis, regulatory agencies have set hemolysis standards as a condition for RBC storage system licensure. In the United States, this standard was historically a mean hemolysis of less than 1%, and in Europe, less than 0.8%. [1]

The actions which can be taken to reduce RBC lysis during storage:

  1. The refrigeration of blood is expected to slow metabolism and thus enhance preservation. Thus maintaining temperature between 2-6 C reduces glucose metabolism and improve red cell viability. [3],[4]
  2. Ployvinyl chloride bags plastisized with DEHP are the standard red cell storage container. The presence of DEHP reduces hemolysis fourfold during storage by intercalating into red cell membrane.
  3. Leukocyte reduction also improves red cell storage by removing highly metabolic and active blood component of white cell that would make the bag more acidic.
  4. Additive solutions containing 30 mM of mannitol reduce hemolysis and further increase the osmolarity of the solution. [4]
  5. A protective layer is recommended between RBC storage and freezing device to maintain the temperature in the RBC storage unit or transportation units. RBC should not be stored close to air-vent in the walk in coolers where temperature may drop lower than 1-6C.
  6. RBC must be transported in an appropriate container that maintains the recommended temperature.
  7. During component separation centrifugation speed higher than 5000 g induces hemolysis, which should be avoided. [5]

   References Top

1.Hess JR, Sparrow RL, van der Meer PF, Acker JP, Cardigan RA, Devine DV. Red blood cell hemolysis during blood bank storage: using national quality management data to answer basic scientific questions. Transfusion 2009;49:2551-4.  Back to cited text no. 1
2.Alessandro A, Liumbruno G, Grazzin G, Zolla L. Red blood cell storage: the story so far. Blood Transfus 2010;8:82-8.  Back to cited text no. 2
3.Klein GH, Anstee DJ. Mollisons's blood transfusion in clinical medicine. 11 th ed. UK: Blackwell Publishing; p. 356-8.  Back to cited text no. 3
4.Hess JR, Solheim BG, Red cell metabolism and preservation. In: Simon TL, Snyder EL, Solheim BG, Stowell CP, Strauss RG, Petrides M, editors. Rossi's principles of transfusion medicine. 4 th ed. UK: Willey Blackwell; p. 62-4.  Back to cited text no. 4
5.Sowemimo-Coker SO. Red blood cell hemolysis during processing. Transfus Med Rev 2002;16:46-60.  Back to cited text no. 5

Correspondence Address:
N Choudhury
Transfusion Medicine, TATA Medical Centre, 14 MAR (EW), New Town, Rajarhat, Kolkata - 700 156
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-6247.76013

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  [Figure 1]

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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
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