Salvage of red blood cell units containing haemolysis by a cell wash process in George Blood Bank

Roelofse, Charlotte

Salvage of red blood cell units containing haemolysis by a cell wash process in George Blood Bank

Author(s)

Roelofse, Charlotte

Date Issued

2026

Type

master thesis

Publisher

Cape Peninsula University of Technology

Abstract

Title: Salvage of red blood cell units containing haemolysis by a cell wash process in George Blood Bank Background: Premature haemolysis in red blood cell (RBC) units received at the George blood bank became problematic. A saline wash method was successfully utilized in other countries to restore red blood cell (RBC) units containing haemolysis, to remove waste products of haemolysis. This saline wash method has not been used in South Africa. Methods The content of the quad bags, used for blood donation, was investigated to determine the cause of premature haemolysis. The volume of the saline, adenine, glucose and mannitol (SAGM) preservatives as well as the citrate, phosphate and dextrose (CPD) anticoagulants were verified to investigate the compliance with the package insert. The haematological autoanalyzer was used to develop a colour chart to be used with the HemoCue at George blood bank to select premature haemolysed RBC units received at the George blood bank.. The RBC units were divided into five groups: a control group which were not haemolysed nor washed (NHNW), non-haemolysed units which were washed and reconstituted in saline (NHWSI), non-haemolysed units washed in saline and reconstituted in SAGM (NHWSGM), haemolysed units washed and reconstituted in saline (HWSI) and haemolysed units washed in saline and reconstituted in SAGM (HWSGM). These units were stored in accordance with WCBS storage guidelines for a period of two weeks. All five groups were initially subjected to a full blood count (FBC) and their haemoglobin, RBC count, haematocrit, mean corpuscular volume, mean molecular haemoglobin, mean corpuscular haemoglobin concentration, white blood cell count, platelet count, RBC distribution width-standard deviation and RBC distribution width - coefficient of variation (RDW-CV) were determined as well as one and two weeks subsequently. Results: The quad bags had inconsistent CPD volumes and were not compliant to the package inserts, whereas the SAGM volumes were compliant. The FBC results at the initial stage as well as after one and two weeks showed that the waste products of haemolysis could be removed and that the RBC remained undamaged, and retained their shape and size. The research question was answered, more cells were lost in the cell wash process for units with premature haemolysis present. About 24% of red blood cells were lost, were in red blood cell units with no haemolysis present the cells in literature is estimated at 20%. The SAGM preserved the cells better than the 0.9% Saline, we only had one outlier that stated differently. Conclusion: Inconsistent anticoagulant levels in the quad bags impacted on the premature haemolysis in the red blood cell units received at the George blood bank. Premature haemolysis is an ongoing challenge, and the colour chart could be useful for visual inspection of haemolysis of the RBC units. This study showed that the washing of premature haemolysis in red blood cell units is viably even when stored for up to 14 days.

Additional information

Thesis (MSc (Biomedical Technology))--Cape Peninsula University of Technology, 2026

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