Adverse Interactions with Medications and Solutions

Description

Several medications and IV solutions, if mixed with red cells in a confined space such as a unit of blood or infusion tubing, may result in adverse effects. No medications or solutions may be routinely added to or infused through the same tubing with blood or blood components, except 0.9% Sodium Chloride Injection (USP). ABO-compatible plasma or 5% Albumin may be used with the approval of the patient’s physician.

The following solutions have known adverse effects on blood components:

• hypotonic solutions (e.g., 5% dextrose) may cause red cells to Iyse
• calcium (e.g., Ringer's Lactate) may cause red cells and plasma to clot

Other solutions intended for intravenous use may be used in an administration set or added to blood or components only under either of the following conditions:

• they have been approved for this use by Health Canada, or
• there is documentation available to show that addition to the component involved is safe and efficacious.

Hypotonic solutions, in particular D5W, or electrolyte solutions containing calcium, such as Lactated Ringer’s Injection (USP), should never be added to or administered concurrently with blood or blood components collected in an anticoagulant containing citrate.

Incidence

The incidence of interactions of blood components with medications and solutions is unknown because of lack of reporting mechanisms to detect incidence or lack of recognition of the interaction as a cause of the adverse effect.