Can dextrose be administered with blood?

Dextrose Should Not Be Administered with Blood

Dextrose solutions should not be administered simultaneously with blood through the same infusion set because of the risk of red blood cell pseudoagglutination and hemolysis. 1, 2

Mechanism of Incompatibility

• When dextrose solutions (particularly D5W or 5% dextrose in water) mix with blood, they cause immediate clumping of red blood cells followed by gross hemolysis within 30 minutes of contact 2
• The FDA drug label specifically states that "dextrose injection without electrolytes should not be administered simultaneously with blood through the same infusion set because of the possibility that pseudoagglutination of red cells may occur" 1
• Even 5% dextrose in 0.225% saline can cause hemolysis within 10 minutes when mixed with blood at body temperature (37°C) 2

Compatible Alternatives for Blood Administration

• Normal saline (0.9% sodium chloride) is the recommended solution for use with blood products and shows no evidence of hemolysis when mixed with blood 2
• 5% dextrose in 0.9% saline also appears to be compatible with blood without causing hemolysis 2

Clinical Implications and Precautions

• Traces of solutions can remain in intravenous administration tubing for up to 30 minutes after a transfusion is started, emphasizing the importance of proper line flushing 2
• When administering blood products:
  • Flush IV lines with normal saline before and after blood administration 2
  • Use a separate dedicated IV line for blood products if multiple infusions are required 1
  • Never use lactated Ringer's solution with blood, as it rapidly produces clots when mixed with CPD (citrate-phosphate-dextrose) blood 2

Special Considerations

• In situations requiring both blood transfusion and dextrose administration (such as in hypoglycemic patients requiring blood):
  • Use separate IV access sites for each infusion 1
  • If only one IV access is available, completely flush the line with normal saline between administrations 2
  • Consider using 5% dextrose in 0.9% saline if both glucose supplementation and isotonic fluid are needed concurrently with blood products 2

Monitoring Recommendations

• Monitor for signs of hemolysis (back pain, hypotension, hemoglobinuria) if there is any concern about inadvertent mixing of dextrose and blood 2
• Regularly check IV tubing for visible clumping or color changes that might indicate an incompatibility reaction 2

Following these guidelines will help prevent potentially serious complications from incompatible IV fluid administration with blood products and ensure safe and effective transfusion therapy.