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PubMed1994

[Anaphylactoid reactions to colloid plasma substitutes: incidence, risk factors, mechanisms. A French multicenter prospective study].

Changes in transfusion behaviour induce a widespread use of colloid plasma substitutes, the range of which has recently been enlarged by the marketing of starch derivatives. The product chosen depends, at least in part, on its adverse effects, anaphylactoid reactions being a part of these. This study aimed to discover the frequency and severity of these reactions according to the type of substitute available in France, to look for possible risk factors, and determine the mechanisms involved. A prospective inquiry was carried out in 49 public and private hospitals spread throughout France. It lasted for 15 months, between June 1991 and October 1992. A data sheet was filled in for each patient who was given a plasma substitute, whether or not there was an incident. When a reaction did occur, an assessment was carried out in two stages: straightaway, with the measurement of the concentrations of serum tryptase, antigelatin antibodies, urinary methylhistamine; and four to six weeks later, with skin tests. A series of 19.593 patients was thus collected: 48.1% were given gelatins, 26.7% starches, 15.7% albumin, and 9.5% dextrans. 43 anaphylactoid reactions were recorded, giving an overall frequency of 0.219%, or 1 reaction for 456 patients. The frequency differed according to the substitute considered: 0.345% for gelatins, 0.273% for dextrans, 0.099% for albumin, and 0.058% for starches. These reactions (grades III and IV) were serious in 20% of cases. Multivariate analysis revealed four independent risk factors: giving gelatins (odds ratio: 4.81), giving dextrans (odds ratio: 3.83), a history of drug allergy (odds ratio: 3.16), and being male (odds ratio: 1.98). The relative risks of anaphylactoid reactions due to one type of substitute with respect to another were estimated to be 6 times less for starches with respect to gelatins, and 4.7 times less than with dextrans. The relative risk of albumin is 3.4 times less than that of gelatins, and almost identical to that of the starches. An immuno-allergological assessment was only carried out in 15 patients who had been given a gelatin (Plasmion). IgE-dependent anaphylaxis was proven in 7 of these. To conclude, it was shown that gelatins and dextrans should be avoided in patients with a known history of drug allergy. When a reaction does occur, an allergological assessment must be carried out, as this may be due to specific antibodies. Should this prove to be the case, that particular substitute would be contraindicated for the rest of the patient's life.

Anaphylaxis↗
PubMed1985

Hemorrheological effects of colloidal plasma substitutes infusion. A comparative study.

Our objective was to investigate experimentally the easily overlooked effect of the clinical use of colloidal plasma substitutes on tissue perfusion. The experimental animals were dogs, and the study was carried out using several independent rheological experimental methods. The following are the principal findings: 1) Based on the observations made under a microscope, the stability of blood suspensions was best maintained by dextran-40 (Dex 40) and hydroxyethyl starch (HES0.55; Hespander), both of which cause little rouleaux formation by erythrocytes. In addition, the electronegativity of the erythrocyte membrane was simultaneously elevated. 2) The blood viscosity was greatly affected by the hematocrit and the serum protein concentration. 3) At a high shear rate, the blood viscosity among these colloidal plasma substitutes showed no great difference after infusion; in contrast, at a low shear rate, the blood viscosity after infusion of Dex 40 or HES0.55 was lower than after other substitutes. 4) The ratio of the viscosity at a low shear rate to the viscosity at a high shear rate is more significant and useful as a clinical indicator. On the basis of the preceding findings, Dex 40 and HES0.55 were generally superior to the other substitutes, especially HES0.55.

Blood Proteins↗
PubMed1997

[The indices of lipid metabolism and of lipid peroxidation in acute intestinal obstruction and the administration of plasma substitute solutions].

The influence of the intravenously infusion of plasma substitute solution from the whey on the some indices of the lipid metabolism and the lipid peroxidation were studied in the experiments on the model of ileus. Resive data indicate the considerable alteration of the lipid peroxidation under ileus. The infusion therapy of the solution from the whey decreased the level of lipoperoxides and malondialdehyde in the liver and reduced the level of beta-lipoproteins in serum of blood.

Acute Disease↗
PubMed1980

An assessment of the potential use of anionic dextrans as a plasma substitute.

Several problems exist when dextrans are used as plasma substitutes. High molecular weight dextrans can cause red cell aggregation and increased blood viscosity. Low molecular weight dextrans, although shown to improve circulation and promote flow, are removed rather rapidly from the circulation due to high premeation rates across capillary walls. In the present study, a small anionic charge is introduced onto the dextran to make it electrostatically negative. Since capillary walls have been shown to retain negatively charged solutes in preference to neutral solutes, the anionic dextran should retain its effectiveness for longer periods of time compared to similar sized neutral dextran. Studies were done on eight unanaesthetized dogs to compare the relative disappearance rates of dextran and anionic dextran (carboxymethyl dextran) from the circulation. It was shown that anionic dextrans do remain in the circulation over a longer period of time compared to neutral dextrans.

Animals↗
PubMed1985

Three per cent dextran-60 as a plasma substitute in blood component therapy. I. An alternative in surgical blood loss replacement.

Microaggregate-poor erythrocyte concentrate with 3% dextran-60 as a plasma substitute was compared with microaggregate-poor whole blood for replacement of intra-operative and immediately postoperative blood loss. Sixty patients undergoing total hip arthroplasty randomly received either of these two forms of therapy. In accordance with the clinical routine of our orthopedic department, an infusion of 500 ml of 6% dextran-70 (Macrodex) was given as thrombo-prophylaxis in both groups. Use of 3% dextran-60 as a plasma substitute in blood component therapy for surgical hemorrhage of up to 50% of the calculated blood volume caused no increase in bleeding tendency or frequency of postoperative hematoma compared with whole blood replacement. Plasma protein levels were low immediately postoperatively in patients given the dextran, but from the 4th postoperative day onward there was no difference between the groups. Applied in clinical practice, this would be efficient in saving plasma for other urgent purposes.

Aged↗
PubMed1985

Three per cent dextran-60 as a plasma substitute in blood component therapy. II. Comparative studies on pre- and postoperative blood volume.

Microaggregate-poor erythrocyte concentrate with 3% dextran-60 as a plasma substitute was compared with microaggregate-poor whole blood for replacement of intra-operative blood loss. Their blood volume-conserving effects were studied by sequential blood volume determination with radioactive technetium (99mTc) in 19 patients undergoing total hip arthroplasty. Pre-operatively there was no difference in blood volume between the groups. Immediately after surgery and on the 2nd postoperative day there was no difference in total blood volume. Blood component therapy with 3% dextran as a plasma substitute is an efficient principle for intra-operative blood loss replacement at hip operations.

Aged↗
PubMed1975

[The effect of the plasma substitutes hydroxyethyl starch and dextrane-60 on the kidney function of dogs in acute haemorrhagic shock (author's transl)].

In 14 dogs during experimentally induced haemorrhagic shock the effects of 6% solutions of hydroxyethyl starch and Dextran-60 were compared. As main parameters of the renal function the arterial and venous pressures, renal blood flow, creatinine-clearance as measure of the glomerular filtration rate, urinary flow rate and urinary excretion of sodium and potassium were estimated. After complete substitution of the lost blood volume both plasma substitutes increased the renal blood flow by 50%. Glomerular filtration rate returned to control values, urinary volume and potassium output increased whereas sodium output decreased slightly. If only 50% of the lost volume was substituted, the renal blood flow and filtration rate remained at or below control values. Hydroxyethyl starch and Dextran-60 proved to be almost equally effective in restoring renal function.

Animals↗
PubMed2004

Thrombelastographic whole blood clot formation after ex vivo addition of plasma substitutes: improvements of the induced coagulopathy with fibrinogen concentrate.

BACKGROUND: Plasma substitutes such as hydroxyethyl starch (HES) and various dextrans may compromise the haemostatic system, thereby causing potentially dangerous bleeding. Whilst several mechanisms have been advanced to explain the nature of the coagulopathy induced by this colloid, there has been comparably little interest in devising ways to optimize haemostasis after a relative colloid overdose. METHODS: Real-time whole blood (WB) clot formation profiles were recorded using a thrombelastographic method employing activation with tissue factor. The coagulation tracings were transformed into dynamic velocity profiles of WB clot formation. WB from healthy individuals (n=20) was exposed to haemodilution of approximately 55% with isotonic saline, HES 200/0.5, HES 130/0.4, and dextran 70, respectively. Possible modalities for improvement of the induced coagulopathy were explored, in particular ex vivo addition of a fibrinogen concentrate. RESULTS: WB coagulation profiles changed significantly with decreased clot strength, and a compromised propagation phase of clot formation. The duration of the initiation phase of WB coagulation was unchanged. No statistical differences were detected amongst the HES solutions and dextran 70. However, dextran 70 returned a more suppressed clot development and strength compared with the HES solutions. Ex vivo haemostatic addition of washed platelets (75 x 10(9) litre(-1)) and factor VIII (0.6 IU ml(-1)) produced insignificant changes in clot initiation, propagation, and in the clot strength. In contrast, ex vivo addition of a fibrinogen concentrate (1 g litre(-1)) improved the coagulopathy induced by all of the three individual plasma expanders tested. CONCLUSION: Coagulopathy induced by haemodilution with either HES 200/0.5, HES 130/0.4, and dextran 70 may be improved by fibrinogen supplementation.

Adult↗
PubMed1990

[Comparative study of the efficacy and tolerability of 2 plasma substitutes used as vascular-loading solutions during plasma exchange].

A 4% human albumin solution in association with colloids was tested in an attempt to reduce the cost of replacement fluids during plasma exchange. In a retrospective study, from May 1988 to December 1989, the efficiency and tolerance of gelatin (Plasmion) and dextran 40 (Plasmacair) were compared. Since June 12, 1989, dextran 40 infused only after administration of dextran 1000 (Promit). Seven hundred and forty eight plasma exchanges were performed in 75 patients; 37 received gelatin (7.24 plasma exchanges/patient), 50 dextran (9.6 plasma exchanges/patient) and 12 both solutions after clinical evidence of intolerance to gelatin. No reaction was noted with dextran 40 used alone or in association with haptenic prevention. The gelatin solution induced 2 immediate allergic reactions and one delayed cutaneous reaction. No cross-reactive allergy was observed between the 2 colloids. Dextran 1000 injections were well tolerated. Gelatin infusions were associated with 10 times more episodes of hypovolemia (5.6 versus 0.62%). This difference is probably linked to a faster elimination of gelatin from the vascular compartment and necessitates the infusion of a larger volume of gelatin, as compared to dextran 40, for the same volume of plasma exchanged.

Drug Hypersensitivity↗
PubMed1990

Plasma substitution with 3% dextran-60 in orthopaedic surgery: influence on plasma colloid osmotic pressure, coagulation parameters, immunoglobulins and other plasma constituents.

To study the effects on plasma proteins, blood coagulation and fibrinolysis of dextran-60, given as plasma volume substitute in a 3% solution, 57 patients were studied preoperatively and for 8 days postoperatively in conjunction with elective orthopaedic surgery. Three groups were formed according to the blood loss during the day of surgery: Group I (n = 22) less than 30%, Group II (n = 24) 30-50% and Group III (n = 11) greater than 50% of the estimated blood volume. Dilution to a haemoglobin concentration of 110 g.1-1 was intended and erythrocytes transfused accordingly. No platelets were transfused. All patients received similar amounts of crystalloids. Nine patients in Group III received plasma and/or albumin solution for further volume replacement once the maximum dose of dextran (1.5 g.kg-1) was reached. Dextran-70 was given on days 1 and 3 postoperatively for thromboprophylaxis. No patient exhibited clinical signs of thrombosis or embolism. Mean postoperative bleeding times were longer than preoperatively, but still within the normal range in all groups. They were both pre- and postoperatively slightly longer in Group III, compared to the other groups, perhaps due to mild haemostatic disorders and/or undisclosed antiphlogistic therapy. Postoperative colloid osmotic pressures decreased by 11-19% in the three groups. Dilution of plasma constituents was also seen in the postoperative fall of platelet counts and of albumin, antithrombin and Factor X levels, most marked in Group III. Albumin levels on day 8 were still only 77-83% of preoperative values. IgG and IgM were decreased and the IgG level was still only 75% of preoperative on day 8.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗