Fluid over load in blood transfusion

[Petra81]

I have a question about fluid overload in blood transfusion versus LR bolus.

When we transfuse blood I was toldd that I can't do it faster than 340 ml/2hr unless patient is actively bleeding out, then it's as fast as possible. Reasoning behind it is that if patient gets too much blood too fast her heart will not handle the fluid overload and her lungs might become edematous and in worst scenario she can have a heart attack. So why it is not a problem with LR which we infuse many times in less than an hour. Is it the composition of blood that it's making it more stressful for the heart?

[nocturnalnurse]

You can fluid overload someone on regular IV fluids as well. I do not have a specific answer as to why it seems to happen more with blood products. My hypothesis is that it is likely because the severe anemia you are treating decreases how well the kidneys work. If the kidneys are not working as well to get rid of excess fluid, fluid overload can then happen. Also, if you get to the point you are giving blood, they have probably already had quite a bit of fluid on board. Also, obsteric patients are at higher risk of fluid overload from many issues such as preeclampsia, oxytocin use, magnesium sulfate use, postpartum blood volume changes, etc... I am always mindful on how much fluid all of my patients have received vs how much they actually needed and what their output has been.

I do find it a little odd that you have to run your unit in over 2 hrs minimum when our organization has a 2hr MAX limit. Most of our products (unless emergent obviously) are run over 1hr average. If we give more than 1 unit, we frequently give lasix to jump start the kidneys to get rid of excess fluid.