Do not mix pRBC infusion with hypotonic solution (i.e D5W). Why?
- The hypotonic solution has a lower osmolarity, will shift into the RBCs, causing swelling and then lysis.
Mixing of pRBC infusion with Ringer Lactate (RL) is not recommended by the AABB. Simultaneous use of 0.9% Normal Saline is the only recommended isotonic solution. Why?
- This stems from a 1975 study that initially demonstrated formation of clots in vitro when whole blood was mixed with RL (ionized calcium catalyzing the coagulation cascade).
- Another study has demonstrated this effect, however also showed no clotting depending on the ratio (1:1 vs. 1:2 or 1:5) used. Other studies ,  support this.
NOTE: A more recent study has found it to be safe. If you have any questions about transfusion practice at your hospital, consult your blood bank medical director.
- S. E. Ryden, H. A. Oberman. Compatibility of Common Intravenous Solutions with CPD Blood. Transfusion. 1975 May-Jun;15(3):250-5.
- Cull DL, Lally KP, Murphy KD. Compatibility of packed erythrocytes and Ringer’s lactate solution. Surg Gynecol Obstet. 1991 Jul;173(1):9-12.
- Lorenzo M, et al. Can Ringer’s lactate be used safely with blood transfusions? Am J Surg. 1998 Apr;175(4):308-10.
- Albert K, et al. Ringer’s lactate is compatible with the rapid infusion of AS-3 preserved packed red blood cells. Can J Anaesth. 2009 May;56(5):352-6. doi: 10.1007/s12630-009-9070-5. Epub 2009 Apr 2
- Levac B, et al. Ringer’s lactate is compatible with saline-adenine-glucose-mannitol preserved packed red blood cells for rapid transfusion. Can J Anaesth. 2010 Dec;57(12):1071-7. doi: 10.1007/s12630-010-9396-z. Epub 2010 Oct 5.