Stored red cells are acidotic, but metabolism of citrate produces an alkalosis. Therefore pH imbalance due to red cell transfusion itself is rare, but hypovolemic shock and the underlying conditions may cause an acidosis.
Plasma colloid osmotic pressure falls as large volumes of crystalloids and red cells without plasma are given. Infusion of colloid may be required to counteract this.
It should be noted that previous standard regimens for managing massive transfusions included fresh frozen plasma, platelets, alkalizing agents, and calcium in fixed amounts according to the volume of red cells transfused. These are often unnecessary and therefore wasteful of limited resources, and may even be harmful. Current recommendations are to give supplements according to each patient's needs based on clinical and laboratory indices.
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