Region / Site descriptor/ logo Red Cell Modification Process

Verified Provincial Template Version 0

Procedure: Washing Red Cells – Manual Method
Unique Identifier: RM 0003

Washing Red Cells – Manual Method

Purpose: This procedure provides instructions for how to wash red cells using a manual
method.

Required Materials:
 3 =Transfer sets
F
 2 =1000mL transfer packs <fs>
 50 mL bag of 0.9% IV saline
 2 = 500 mL bags of 0.9% IV saline
 Modified blood product label with an approved adhesive for use on blood products:
 Metal sealing clips <fs>
 Plastic overwrap bag

Required Equipment:
F  Refrigerated centrifuge <fs>
 Centrifuge buckets <fs>
 Harvard trip balance
 Balance weights <fs>
 Hemostats
 Electric tube sealer or handsealer <fs>
 Plasma extractor <fs>
 Scissors

Procedure A: Preparing the Red Cell for Washing

Related
Documents
Action Title
Number
Note: The washing of red cells must be performed aseptically and in a clean Modifying
Blood
area separate from the laboratory testing area. Products using
Aseptic
Technique

1 Prepare the refrigerated centrifuge.

F  Turn on the refrigerated centrifuge.
 Set the temperature / Select program <fs> for 4oC.
 Allow the centrifuge to each 4oC on the temperature indicator.
 Note: This may take 15 minutes.

2  Obtain the red cell unit to be washed from the designated refrigerator Visual
Inspection of
storage area. Blood
 Perform a visual inspection on the red cell unit per established procedure. Products
XXXXX

3  Compare the compatibility tag with the red cell unit to determine that the Selecting Red
Cells for
following matches: Crossmatch
o Unit number XXXXX

© Provincial Blood Coordinating Office, 2006. All Rights Reserved. Page 1 of 5

Created By: PBCO in partnership with the Health Authorities of British Columbia
Revised: 01-Jul-06
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 Region / Site descriptor/ logo Red Cell Modification Process

Verified Provincial Template Version 0

Procedure: Washing Red Cells – Manual Method
Unique Identifier: RM 0003

Related
Documents
Action Title
Number
o ABO/D
o Red cell attributes
 Check that the red cell attributes on the red cell unit matches the red cell
attributes on a patient’s record and request form and is appropriate for the
diagnosis.

4 Prepare a modified blood product label for the washed red cells per Modified Blood
Product Label
established procedure. See Appendix A <fs> Preparation
F Include the: Procedure
 Unit number Appendix A:
 ABO/D Example of a
Completed
 Modification – “Washed” Modified Blood
 Anti-CMV negative label (where applicable) Product Label
 Antigen negative label (as applicable)
 Irradiated label (where applicable)

5  Put on clean gloves Modifying

Blood
 Use aseptic technique per established procedure. Products by
Aseptic
Technique XX

6 Label the transfer pack temporarily with the:

 Unit number
 ABO/D
 Unit attributes as applicable (e.g.: irradiated, anti-CMV negative)
 Patient identification

7 Pre-dilute the red cells.

a. Obtain a transfer set. Close the roller clamp on the transfer set.
b. Remove the protective cap from the port of a 500 mL bag of 0.9% IV
saline.
c. Remove the protective cap from the spike of the transfer set.
d. Insert the transfer spike into the port of the saline bag.
e. Remove the protective cap from the red cell unit.
f. Remove the protective cap from the other spike of the transfer set.
g. Insert the transfer spike into the port of the red cell unit.
h. Open the roller clamp between the saline and the red cell unit.
i. Allow the saline to flow into the red cell unit until the unit is full.
j. Seal the transfer set with electric tube sealer or hand sealer with metal
F clips. <fs>
k. Mix the red cell unit gently by inverting it several times.

8 Place the red cell unit into a plastic over wrap bag and put into a centrifuge
bucket in an inverted / upright <fs> position.
 <fs> Instructions for upright or inverted spin.
F

© Provincial Blood Coordinating Office, 2006. All Rights Reserved. Page 2 of 5

Created By: PBCO in partnership with the Health Authorities of British Columbia
Revised: 01-Jul-06
Approved By: <facility specific>
Pathname: /conversion/tmp/scratch/47953720.doc
 Region / Site descriptor/ logo Red Cell Modification Process

Verified Provincial Template Version 0

Procedure: Washing Red Cells – Manual Method
Unique Identifier: RM 0003

Related
Documents
Action Title
Number
 Place the centrifuge bucket on the Harvard trip balance.
 Balance the red cell unit with another centrifuge bucket and added weights
as required. <fs>

9 Centrifuge the red cell unit in the refrigerated centrifuge.

 Open the centrifuge door and remove the inner lid.
 Place the centrifuge buckets into opposing rotor compartments of the
centrifuge.
F  Replace the inner lid.
 Confirm program setting or set as follows: <fs>
o [rev/min] dial = for the posted speed
o [time] dial = for the posted time
o [brake] dial = for the posted time
 Press the [start] switch.
 Watch the [rev/min] indicator until the centrifuge reaches posted speed.
10  Remove the centrifuge bucket with the red cell unit from the centrifuge
 When the centrifuge stops / centrifuge alarm sounds. <fs>
 Open the centrifuge door and remove the inner lid.
F
 Remove the centrifuge buckets containing the red cell unit and balance
weight.
 Carefully remove the red cell unit from the plastic over wrap bag and
hang.<fs>

11  Put on clean gloves Modifying

Blood
 Use aseptic technique as per established procedure. Products by
Aseptic
Technique
XXXXX

12 Remove the supernatant from the red cell unit. <fs> Instructions for type of
F spin (upright or inverted) used.

13 Repeat steps 7 to 12 above as applicable. <fs>

Note: If the patient is IgA deficient, repeat steps 7 to 12 four more times for a
F wash with 3000 mL saline.

14  Perform a hematocrit on the washed red cell unit. See Appendix C. Appendix C:
Sampling Red
 Adjust the hematocrit to 0.60 – 0.80 with 0.9 % IV saline, if applicable Cells for a
OR <fs> Hematocrit
F  Add 50 ml 09. % IV saline to the washed red cell unit using a new transfer
set.
15  Seal and cut the transfer tubing away between the red cell unit and the
saline bag.
 Mix the washed red cell unit gently.

© Provincial Blood Coordinating Office, 2006. All Rights Reserved. Page 3 of 5

Created By: PBCO in partnership with the Health Authorities of British Columbia
Revised: 01-Jul-06
Approved By: <facility specific>
Pathname: /conversion/tmp/scratch/47953720.doc
 Region / Site descriptor/ logo Red Cell Modification Process

Verified Provincial Template Version 0

Procedure: Washing Red Cells – Manual Method
Unique Identifier: RM 0003

Related
Documents
Action Title
Number

16 Affix the completed modified blood product label to the washed red cell unit.

17 Record the red cell washing modification in the computer or ledger <fs> Computer
Manual
per established procedure. See Appendix B.
F Appendix B:
Example of a
Completed
Screen or
Ledger

18 Determine the final need of the washed red cell unit. Manual
Reconstituting
of Red Cells
If the washed unit is to be used Then proceed to for Exchange
Transfusion
for reconstituting as whole blood for Manual Reconstituting of Red Cells for Procedure
exchange transfusion Exchange Transfusion procedure.

as prepared step 19.

19 Revise / Reprint <fs> the transfusion record and compatibility tag to include
the revised:
F  blood product modification, and
 expiry date and time (24 hours from the time of opening the red cell unit).

20 Attach the revised compatibility tag to the washed red cell unit.

21 Store the labelled and tagged washed red cell unit in the designated Storing Blood
Products
refrigerator area. <fs> XXXXX
F
22 Notify the nursing unit that the washed red cell:
 is available, and
 will expire at ___ date/time.

23 Proceed to Issue and Return Process when the nursing unit is ready to Issue and
Return
transfuse the red cell unit. Process

References:
Electric tube sealer instruction manual <fs>
Refrigerated Centrifuge Operator’s Manual F

© Provincial Blood Coordinating Office, 2006. All Rights Reserved. Page 4 of 5

Created By: PBCO in partnership with the Health Authorities of British Columbia
Revised: 01-Jul-06
Approved By: <facility specific>
Pathname: /conversion/tmp/scratch/47953720.doc
Region / Site descriptor/ logo Red Cell Modification Process

Verified Provincial Template Version 0

Procedure: Washing Red Cells – Manual Method
Unique Identifier: RM 0003

Appendixes:
Appendix A: Example of a completed modified blood product label <fs>
Appendix B: Example of a completed computer screen or ledger <fs> F

© Provincial Blood Coordinating Office, 2006. All Rights Reserved. Page 5 of 5

Created By: PBCO in partnership with the Health Authorities of British Columbia
Revised: 01-Jul-06
Approved By: <facility specific>
Pathname: /conversion/tmp/scratch/47953720.doc