Can D5 (Dextrose 5%) containing IV (intravenous) fluids be used as a mainline during blood transfusion?

D5-Containing IV Fluids Should NOT Be Used as Mainline During Blood Transfusion

D5-containing IV fluids are contraindicated for co-infusion with blood products due to risk of hemolysis and RBC clumping. Only 0.9% normal saline should be used as the mainline fluid during blood transfusion.

Evidence Against D5 Solutions During Transfusion

Immediate Hemolysis Risk

• Blood mixed with aqueous dextrose solutions (D5W) shows immediate clumping with gross hemolysis occurring within 30 minutes of incubation 1
• D5 in 0.225% saline causes hemolysis within 10 minutes when mixed with CPD-anticoagulated blood at 37°C 1
• The hypotonic nature of dextrose solutions causes osmotic stress on red blood cells, leading to cellular swelling and membrane rupture 1

RBC Quality Deterioration

• When RBCs are incubated with D5W for 180 minutes, significantly greater hemolysis occurs compared to RBCs alone (p<0.05) 2
• Mean corpuscular volume increases abnormally when RBCs contact D5-containing solutions for more than 30 minutes (p<0.01) 2
• D5W/0.2% saline similarly produces increased hemolysis after 180 minutes of contact 2

Safe Alternative: 0.9% Normal Saline Only

Why Normal Saline is Safe

• No hemolysis occurs when blood is mixed with 0.9% normal saline, making it the only acceptable co-infusate 1
• RBCs co-infused with 0.9% saline maintain normal hematocrit, hemoglobin, and morphology without adverse effects 2
• Normal saline is isotonic and does not cause osmotic shifts that damage red blood cell membranes 1

Critical Clinical Pitfalls to Avoid

Residual Dextrose in IV Lines

• Traces of previously infused solutions remain in IV tubing for at least 30 minutes after switching fluids 1
• If a D5-containing solution was running through the line, flush thoroughly with normal saline before initiating blood transfusion 1
• Never assume the line is clear simply because you've changed the bag—residual fluid persists in the tubing 1

D10W Exception (Neonatal Context Only)

• D10W does not adversely impact RBC characteristics when co-infused through neonatal transfusion apparatus 2
• This exception applies only to neonatal populations using specialized low-volume apparatus that minimizes contact between the coinfusate and RBCs 2
• For standard adult transfusions, this exception does not apply—use only 0.9% saline 2

Practical Algorithm

1. Stop any dextrose-containing infusion running through the intended transfusion line
2. Flush the IV line with at least 30 mL of 0.9% normal saline to clear residual dextrose 1
3. Connect blood product with 0.9% normal saline as the only concurrent infusate 1, 2
4. If patient requires glucose supplementation, use a separate IV line for D5-containing solutions 1