Square Pants said:
Lactated Ringer's solution should not be used because it contains calcium, which combines with the anticoagulation citrate in the blood component's preservative solution and causes clotting.
Five percent dextrose solution also should not be used because it is hypotonic and may cause red blood cells to hemolyze.
That's 1960's medicine dude. Its ok to use LR with PRBC's.
Surg Gynecol Obstet. 1991 Jul;173(1):9-12. Related Articles, Links
Comment in:
J Am Coll Surg. 1994 Nov;179(5):635.
Compatibility of packed erythrocytes and Ringer's lactate solution.
Cull DL, Lally KP, Murphy KD.
Department of Surgery, Wilford Hall USAF Medical Center, Lackland, Texas 78236-5300.
Packed erythrocytes are frequently reconstituted with crystalloid during rapid infusion. Dilution of whole blood with calcium containing solutions, such as Ringer's lactate has been cautioned against, citing possible clot formation because of chelation of the citrate anticoagulant. We studied the compatibility of Ringer's lactate solution and citrate phosphate dextrose (CPD)-preserved packed erythrocytes to evaluate the safety of using Ringer's lactate solution as a diluent in the emergency setting. Aliquots of CPD-preserved packed erythrocytes were diluted with either Ringer's lactate or normal saline solutions in ratios between 5:1 to 1:20 (packed erythrocyte to crystalloid), incubated at room temperature or 37 degrees centigrade and examined for clot formation at intervals up to two hours. Although clotting occurred at dilutions of 1:1 (packed erythrocytes to Ringer's lactate solution) and beyond, no clot formation occurred in the clinically relevant dilutions between 5:1 and 2:1. Thirty-two additional units of CPD-preserved packed erythrocytes were diluted to hematocrit values of 35, 45, 55 or 65 per cent and passed through a 170 micron filter. Flow rates of packed erythrocytes diluted with Ringer's lactate and normal saline solutions were compared. There was no difference in flow rates between packed erythrocytes diluted with Ringer's lactate compared with normal saline solutions. Ringer's lactate solution can be safely used as a packed erythrocyte diluent in patients requiring rapid blood transfusions.
PMID: 1866680 [PubMed - indexed for MEDLINE]
Am J Surg. 1998 Apr;175(4):308-10. Related Articles, Links
Can Ringer's lactate be used safely with blood transfusions?
Lorenzo M, Davis JW, Negin S, Kaups K, Parks S, Brubaker D, Tyroch A.
Department of Surgery, University of California, San Francisco/Fresno Valley Medical Center, USA.
BACKGROUND: Blood bank recommendations specify that Ringer's lactate solution (LR) should be avoided while transfusing blood. However, there are few studies either evaluating or quantifying increased coagulation during rapid infusion of LR and blood. DESIGN AND METHODS: Whole blood (WB, n = 25) and packed red blood cells (PRBC, n = 26) were rapidly admixed with normal saline (NS), Lactate solution and LR with 1 g (LR-1), 2 g (LR-2), and 5 g (LR-5) CaCl2/L solutions for assessment of infusion time, filter weight, and clot formation. RESULTS: No significant differences in infusion time or filter weight using WB or PRBC with NS or LR were seen. No significant difference in clot formation between NS and LR with WB or PRBC was found, but the presence of visible clot was increased in the LR-5 group (P = 0.013, WB, and P = 0.002, PRBC). CONCLUSION: A comparison of LR and NS with rapid infusion rates of blood showed no significant difference between infusion time, filter weight and clot formation. Blood bank guidelines should be revised to allow the use of LR in the rapid transfusion of PRBC.
PMID: 9568658 [PubMed - indexed for MEDLINE]
