Compatibility of blood with solutions containing calcium

Area of Science:

• Transfusion Medicine
• Biomaterials Science

Background:

• Blood transfusions often involve co-administration with crystalloid solutions.
• Citrate-phosphate-dextrose (CPD) is a common anticoagulant used in stored blood.
• Potential interactions between blood components and crystalloid solutions require investigation.

Purpose of the Study:

• To investigate the potential for clot formation when CPD-anticoagulated blood is administered through standard blood sets after exposure to various crystalloid solutions.
• To identify specific crystalloid solutions that may contribute to clot formation.

Main Methods:

• CPD-anticoagulated blood was passed through administration sets.
• The blood was exposed to Ringer-lactate (BP), Hidroliet, Maintelyte, Plasmalyte B, and 0.9% saline, both before and after the crystalloid solutions.
• Clot formation was assessed, and clots were analyzed using electron microscopy.

Main Results:

• Clot formation, containing fibrin, occurred distal to the filter when using Ringer-lactate and Hidroliet solutions.
• No clots were observed when using Maintelyte, Plasmalyte B, or 0.9% saline.
• Electron microscopy confirmed the presence of fibrin within the formed clots.

Conclusions:

• The calcium content in Ringer-lactate and Hidroliet solutions is implicated as the cause of fibrin clot formation.
• Given the frequent use of these solutions with blood, particularly in shocked patients, alternative solutions are recommended.
• Using calcium-free Ringer-lactate or other crystalloids like 0.9% saline or Plasmalyte B is advised to prevent transfusion-related clotting complications.