Q: 28 year male start having fever, chills, hypotension 10 minutes after start of pRBC transfusion, You suspect "transfusion reaction". You stopped transfusion and advised nurse not to discard bag and tubing and start IVF. Blood bank is notified. Which IVFs should be avoided in such situation?

Answer: LR and any dextrose contain solutions

Lactate Ringer contains calcium and may precipitate clotting of any blood remaining in the intravenous line. Dextrose-containing solutions should be avoided as dextrose may hemolyze any of the remaining red cells in the line. Normal saline is preferred with 100 to 200 cc/hour (watch for volume overload situation for CHF patients) to target a urine output above 100 cc/hour.