【Objective】 To explore the causes and nursing strategies of red blood cell spillage in apheresis platelet donors, so as to avoid adverse reactions to blood donation and platelet discarding and improve blood donation services. 【Methods】 A nursing flowchart for red blood cell spillage was developed based on literature. One case of red blood cell spillage in a apheresis platelet donor as attached, and corresponding literature review was conducted. 【Results】 After the nursing intervention through the nursing flowchart of red cell spillage, platelet apheresis was successfully conducted. The donor felt good and did not experience any adverse reaction to blood donation, and with no more red blood cell spillage. By reviewing relevant literature, the incidence, principles, causes, treatments, prevention of adverse reactions to blood donation and psychological care methods of red blood cell spillage were systematically summarized. 【Conclusion】 Red blood cell spillage in apheresis platelet donors occurs occasionally, and a flowchart of care for red blood cell spillage can help blood station staff quickly identify the cause and handle it correctly to avoid mishandling whicn can result in adverse reactions or discarding of platelets.