Blood Products, Plasma Expanders, and Hemostatics

Aprotinin administration during surgery should follow heparin treatment to avoid any risk. Patients under the treatment of antifibrinolytic therapy should be treated cautiously when coadministering drugs affecting hemostasis and estrogens.229 Accumulation of albumin may occur in patients with impaired renal function if large volumes of albumin solutions are administered. 

Care must be exercised to include 0.9% sodium chloride or 0.5% glucose when diluting albumin solutions. Accidental dilutions with water makes it hypoosmolar, and such a dose may cause severe hemolysis and renal failure.230,231 

Aprotinin Aprotinin should not be mixed with corticosteroids, heparin, nutrient-containing amino acids or fat emulsions, and tetracyclines. Care must be exercised when diluting solutions of colony-stimulating factors, as they become adsorbed to glass or plastic materials, and the preparation must contain a carrier protein such as albumin to avoid the losses. 

Plasma volume expanders such as dextrans may be incompatible at acidic pH.60,70 Care must be exercised with dilutions. Crystals that are formed upon storage may be redissolved by gentle warming. Care must be exercised when preparing doses of recombinant human erythropoietin solution for neonates to maintain the necessary amount of carrier proteins in the formulation 232 

Gelatin plasma expanders should not be mixed with vancomycin. Hetastarch is incompatible with many injectable antibiotics and critical care drugs. 

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