LRS vs Citrate: Friend or Foe?

Imagine having a patient who needs simultaneous administration of a citrated blood product and Lactated Ringer’s solution (LRS), but there is only one available peripheral catheter.

Can you administer citrated donor blood or plasma and LRS at the same time?

Conventionally, this practice is discouraged because LRS is a calcium-containing fluid that may be incompatible with citrate due to the risks of calcium chelation and clot formation. Once LRS exceeds the chelating capabilities of the citrate in the stored blood that may result in clot formation, which makes perfect sense. However, as we all know, theory and practice are not the same in clinical medicine. Therefore, let’s explore the evidence to answer this very practical question.

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