RED
BLOOD CELL GLYCEROLIZATION WORKSHEET
UNIT #: ___________ DATE COLLECTED: ___________ |
| DATE FROZEN: ___________ |
| COLLECTION
INFORMATION ANTICOAGULANT: ___________ PRESERVATIVE: AS1 AS3 AS5 NONE |
| CENTRIFUGED
AT 1615 X g for 4 MINUTES TO PREPARE RED CELL CONCENTRATE: YES ____ NO ____ |
| IF NO, WHY:_____________________________________________________ |
| FREEZE BAG: 800 ML PVC _______ 1000 ML PVC_______ |
| MANUFACTURER:_______ LOT #: _______ EXP DATE: _______ |
| NET WEIGHT |
| PRIOR TO GLYCEROL ADDITION: __________ g |
| FOLLOWING GLYCEROL ADDITION: __________ g |
| VOLUME OF GLYCEROL ADDED: __________ ml |
| GLYCEROL: MANUFACTURER: _______ LOT #: _______ EXP DATE: _______ |