Hey allI've been thinking a lot lately about WHY we can't give meds into a line that's running blood, I guess because I've had a patient in DIC (thus needing lots of products) who is also an access nightmare, so the timing of meds has been tricky. The only reference I've been able to find says that glucose (as in IVF) causes clumping, and calcium reverses the anticoagulant added to the blood in the blood bank.But... and I realize that this is so simplistic... IV meds go into the patient's circulation. Which is full of blood. And their blood doesn't clump or clot. So where's the problem? Is it that PRBCs, platelets, FFP, etc are different than the actual circulating blood because they're just components? If that's the case, could you give meds with a whole blood transfusion? Does the blood change in some way when it's separated into components and stored? I know the K goes up, but other than that, what? If there *is* something different about blood bank blood, what about double volume exchange transfusions? Does that blood react badly with medications once it's in the patient? We push meds directly into ECMO pumps all the time, which if you think about it is kind of like an enormous blood transfusion.I'd love it if someone could explain the actual physiology of this to me. Obviously there's a good reason, or we wouldn't be so fanatical about it, but the logic doesn't track for me.