SYNOPSIS Red blood cells aggregated by 5 % dextrose solutions are rapidly destroyed in the circulation, as demonstrated by radio-chromium studies. Possible mechanisms are discussed.The aggregation of red blood cells into macroscopic clumps in the presence of 5 % dextrose solutions is a familiar sight to most clinicians who have transfused blood and dextrose in succession through the same giving-set, particularly since the introduction of transparent plastic tubing (Fig. 1). As the proportion of dextrose to blood increases within the tubing, the residual red cells form large aggregates which are capable of obstructing the lumen of the needle. The phenomenon is reversible since the addition of small amounts of electrolytes causes the clumps to disperse: this is presumably what occurs should these aggregates enter the circulation.In an attempt to determine whether this aggregation has any clinical significance and if possible to elucidate its mechanism, red cell survival studies were made using radio-chromium. MATERIALS AND METHODS DEXTROSEThe 5 % dextrose solutions used in this investigation were prepared according to B.P. specifications for infusion.RADIO-CHROMIUM TAGGING Samples of blood, each of 10 ml., were taken from normal subjects and the cells labelled with approximately 75 yg. 51Cr. as sodium chromate by a modification of the established method (Wetherley-Mein, Epstein, Foster, and Grimes, 1958). The suspension was then centrifuged, the supernatant fluid replaced by 20 ml. 5% dextrose solution and after 15 minutes the fresh suspension was re-injected into the donor's circulation. Erythrocyte survival was studied by examination of samples taken 15 minutes and one hour after the injection and subsequently at daily intervals for four days. Assessment of red cell destruction was expressed as 'percentage chromium loss per day', up to 5 % chromium loss per day being accepted as normal.
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