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Drug or Drug Additive
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Consequence
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propylene glycol or other solvents
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hemolysis of red blood cells, drug precipitates
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very high or very low pH
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hemolysis of red blood cells
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poorly soluble medications
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drug precipitates
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IV Solution
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Consequence
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5% dextrose in water
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clumping and hemolysis of red blood cells
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hypotonic or hypertonic solutions
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hemolysis of red blood cells
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calcium containing (Ringer's lactate, others)
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blood clots
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total parenteral nutrition (TPN)
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very hypertonic, with red cell hemolysis
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Other problems with adding or infusing drugs with red blood cell products:
(1) If an adverse reaction develops, it may be impossible to distinguish an adverse drug reaction from a transfusion reaction.
(2) If the blood product is discontinued prematurely, then it may be difficult to determine how much of a drug was given (although this can be estimated if the pre- and post-transfusion volume of the blood product is recorded).
(3) Bacterial contamination.
(4) Drugs added or infused with platelet concentrates may cause platelet clumping.
(5) If filters are not used in the infusion set-up then microembolization may occur.
Recommendations:
(1) Normal saline (0.9% sodium chloride) is the preferred solution for diluting or infusing with blood cell products.
(2) If red blood cells are infused through an existing infusion set, close off all other solutions and run normal saline through the line for at least 15 minutes (preferably 30 minutes) before infusing blood through the line.
(3) Isotonic calcium-free electrolyte solutions may be used in place of normal saline, but the suitability should be verified prior to use.
