Visual Inspection Tool

Primary target audience: all personnel in the hospital setting who handle blood components for transfusion

Date published: January 2024




  • The Visual Inspection Tool replaces the Visual Assessment Guide and may be viewed on a desktop or mobile device. It is not intended for printing. 
  • Canadian Blood Services protocols and procedures determine the acceptability of a blood component for distribution. 
  • The Visual Inspection Tool is an educational resource meant to inform the user about visual variability of blood components and its causes. Whether or not a blood component is suitable for transfusion is determined by local hospital policy and procedures. 

The Visual Inspection Tool is a bench-level tool that depicts variation in the typical appearance of blood components. It was developed for all personnel in the hospital setting who handle blood components for transfusion and, as no two blood components will look exactly the same, should be used in conjunction with other required protocols or work instructions for the visual inspection of components. Please note that blood products such as plasma protein and related products are not addressed in this tool. Terminology used in the Visual Inspection Tool is defined on the terminology page.    

Whole blood donations are manufactured into red blood cells (RBC), platelets, plasma and cryoprecipitate (see Chapter 2, Blood components, of the Clinical Guide to Transfusion for an overview of manufacturing processes). Many factors influence the quality and appearance of a blood component, including temperature, donor characteristics, and contaminants. Although Canadian Blood Services uses strict protocols to manufacture blood components, blood components may be exposed to conditions that alter their appearance after manufacturing, such as during distribution or storage.

How to use the Visual Inspection Tool

The Visual Inspection Tool is divided into separate pages based on four component types (RBCs, platelets, plasma and cryoprecipitate). For each of these four component types, a number of conditions that may be associated with a change in their appearance have been identified.  

Use the menu on the left side to enter the Visual Inspection Tool. Click on your component of interest (e.g., RBCs) or go directly to the condition of interest (e.g., RBCs: hemolysis)  

Within the Visual Inspection Tool, buttons along the top of each page represent different conditions (e.g., lipemia, bacterial contamination) associated with that component type.  

  • Click on one of the buttons to see photos of units affected by that condition, viewed alongside a typical unit.  

  • If additional photos are available for a specific condition, the photo tile will indicate “Click to see more examples.” Clicking on a photo tile will open a window [modal] where users can scroll through additional photos. To close the window, select the “X” in its top right corner (avoid using the back button on the browser window, as this will return to the main Visual Inspection Tool landing page).  

  • To navigate to a different component type, use the drop-down menu available on the top right of each component type. Or, use the breadcrumbs above the banner heading to navigate back to the Visual Inspection Tool menu on the homepage.  

Inspection of the blood components should take place in a well-lit area.  

Important disclaimer: The labels that appear on component photos used in the Visual Inspection Tool may represent local labelling practices, not necessarily the labelling practices of Canadian Blood Services. The Visual Inspection Tool is not intended to be used to verify the placement, appearance or specifications of labels.  

Labelling of blood and blood components in Canada follows the Canadian Guidelines for the Uniform Labelling of Blood and Blood Components Using ISBT 128. See our Uniform labelling best practice, which includes a link to the Canadian guidelines for the uniform labelling of blood and blood components using ISBT 128

Do you have concerns about a component's appearance?

If questions arise about a component's appearance and potential safety for transfusion, please segregate/quarantine the component in question and contact the local Canadian Blood Services distribution department for further direction and report it through the Hospital Customer Feedback page ("Provide feedback" button) on

Have you seen an atypical component?

If you see a component with an unusual or atypical appearance, please take a photo (higher resolution is preferred) and share it with us so it may be considered for inclusion in the Visual Inspection Tool. Photos will be credited and only used with permission.

To submit a photo, go to the Hospital Customer Feedback page, click the “Provide feedback” button, then click the “Report a problem” button (Note: not all atypical components are “problems”, but this is the best way to provide a photo attachment and a description of your component). In the “Event description” field please type “Potential VIT photo” along with a description of your component.  

Quick guide to component variation

Table 1 is a quick guide for different conditions and characteristics associated with a visually detectable change in a component’s appearance.

Table 1. Quick reference guide to conditions or characteristics associated with component variation

Condition or characteristic Appearance of red blood cells (RBCs)/whole blood Appearance of plasma-containing components
(i.e., plasma, platelets and cryoprecipitate)
  • Loss of intact RBCs results in lower hematocrit and a brighter red colour
  • Free hemoglobin imparts a light pink tinge to a dark red almost purple colour to the supernatant
  • Varies from a light pink colour tinge to orange to marked red discolouration
Red cell contamination n/a
  • Varies from a light pink colour tinge to orange to marked red discolouration
  • Lighter shade of red and increased cloudiness of the unit similar to a strawberry milkshake
  • Milky white appearance
  • Cloudiness/decreased lucency
  • Milky white appearance
Bacterial contamination
  • Dark purple to black discolouration in red cell units
  • Excessive air bubbles
  • Clots and fibrin strands
  • Cloudiness
  • Because of possible hemolysis, a pink to red discolouration may be seen in supernatant
  • Excessive air bubbles
  • Clots and fibrin strands
  • Cloudiness
  • Grey discolouration (unique to platelets)
Particulate matter/Aggregates
  • Aggregates vary from flattened specks to a greasy film
  • Cold agglutinins form large RBC masses that do not dissipate with gentle manipulation
  • Particulate matter may appear as white and opaque masses that do not dissipate with gentle manipulation
  • Particulate matter may vary considerably in size
  • Clots appear as small to large dark red or purple masses that do not dissipate with gentle manipulation
  • Fibrin appears as fine white to yellow coloured strands
Plasma discolouration n/a
  • Pink, red, bright orange/yellow, bright green or brown
  • Icteric plasma can appear bright yellow to brown


Canadian Blood Services extends its thanks to everyone who contributed to the development of this tool. 

Tricia Abe 
Rosanne Dawson
Brandie Dennis 
Shelley Doyle 
Michael Ducharme 
Akash Gupta 
Dorothy Harris 
Stacey Hayes  
Anita Howell 
Jayshri Lad 
Wanda Lefresne 
Ken McTaggart
Mallika Pillai 
Katherine Serrano
Salma Sabbar 
Abby Wolfe 
Heather VanderMeulen 
Michelle Zeller  

How to cite the Visual Inspection Tool

Canadian Blood Services. Visual Inspection Tool [Internet]. Ottawa: Canadian Blood Services; 2023 [cited YYYY MM DD]. Available from:


  1. AABB. Blood Components Visual Inspection Guide. 2009.
  2. AABB. Standards for Blood Banks and Transfusion Services, 33rd edition.  2022.
  3. Applicant: Department of the Navy, Navy Hospital, Bethesda, Md, US. FDA summary basis of approval for red blood cells frozen and red blood cells deglycerolized (Reference number 86-0335). 1986. (License number 635-10).
  4. Canadian Standards Association Group. CAN/CSA-Z902:20 - Blood and blood components, (CSA, Canada, 2020)
  5. Council of Europe. Guide to the preparation, use and quality assurance of blood components. 20th edition. : European Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM); 2020.
  6. Devine D. Investigation of white particulate matter found in red cell concentrates. Canadian Blood Services. 2003
  7. Feys H, Devloo R, Pourcq K, Coene J, Vandekerckhove P, Compernolle V. Apheresis platelet concentrates containing visible particles are not inferior to particle-free concentrates, in vitro. Vox Sanguinis. 2013;105:11.
  8. Houseworth JL, Parks JA, Miguel EA, McCarthy LJ, Danielson CF. Transfusion medicine illustrated. Iatrogenic green plasma. Transfusion. 2005;45(7):1047.
  9. Janatpour KA, Paglieroni TG, Crocker VL, DuBois DJ, Holland PV. Visual assessment of hemolysis in red blood cell units and segments can be deceptive. Transfusion. 2004;44(7):984-9.
  10. Naghadeh HT, Pirmohamadjamaat Z, Ferdowsi S, editors. The air bubbles and foam in the bag of platelet: effects on the quality of the final product. 2017.
  11. Sandgren P, Saeed K. Storage of buffy-coat-derived platelets in additive solution: in vitro effects on platelets of the air bubbles and foam included in the final unit. Blood Transfus. 2011;9(2):182-8.