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PubMed1983

Use of plasma volume substitutes and plasma in developing countries.

Plasma and plasma substitutes are used in the treatment of various conditions such as haemorrhage and shock. This article examines the role of crystalloids, artificial colloids, human plasma, human albumin, and plasma protein fraction, in the treatment of such patients, with particular reference to peripheral health facilities in developing countries.It is concluded that 0.9% saline, together with 5-6% dextrose, is of particular importance in this situation since it is easy to produce locally, is stable at high temperatures, and has a low cost/benefit ratio. The second priority is to ensure the availability of a limited quantity of one or more colloid plasma substitutes. In the field of plasma, fresh frozen or fresh liquid plasma is most useful for the treatment of various haemostatic derangements and follow-up treatment of severe burns, since it contains the widest spectrum of therapeutically useful components and can be produced locally with an acceptable degree of difficulty.The treatment of severe diarrhoea with special alkaline electrolyte solutions and oral rehydration solutions is also outlined.

Burns↗
PubMed1979

[Efficacy of plasma substitutes of different molecular weight in acute haemorrhagic shock in dogs (author's transl)].

Dogs were bled into haemorrhagic shock. They were then given isovolaemic infusions of dextran 60 and 40 and of hydroxyethyl starch with an average molecular weight of 200,000 and 40,000 respectively with a view of assessing the haemodynamic efficacy of these plasma substitutes. Solutions of high molecular weight hydroxyethyl starch (HES 400) were retained in the circulation for about the same length of time as was dextran 60. HES 40 (molecular weight 40,000) was retained for about 3-4 hours as measured by cardiac output. For normalizing a relative hypovolaemia, e.g. during anaesthesia or in some emergencies, colloidal plasma substitutes which will be retained for only a short time are entirely satisfactory.

Acid-Base Equilibrium↗
PubMed2005

Plasma substitutes.

Adequate restoration of intravascular volume remains an important therapeutic manoeuvre in managing the surgical, medical and the critically ill intensive care patient. Definition of the ideal volume replacement strategy still remains one of the burning problems. The choice between colloid and crystalloid solutions continues to generate controversy. The highly controversial crystalloid/colloid dispute has been enlarged to a colloid/colloid debate because aside of the natural colloid albumin several non-protein (synthetic) colloids are available as plasma substitutes (e.g. dextrans, gelatins, hydroxyethyl starch [HES] solutions). Due to their varying physico-chemical properties, these solutions widely differ with regard to their pharmacokinetic and pharmacodynamic properties as well as to their hemodynamic efficacy and side-effects. HES is the most intensively studied plasma substitute. The different HES preparations are defined by concentration, molar substitution (MS), mean molecular weight (MW), and the C2/C6 ratio of substitution. Two new HES specification, a third-generation HES with a lower Mw and a lower MS (6% HES 130/0.4) than all other HES preparation and a first-generation HES prepared in a balanced solution, may be promising by improving the therapy of the hypovolemic patient. Albumin cannot be recommended for correction of hypovolemia because of ist extreme costs and because it can easily be replaced by other no-protein colloids. Dextrans should also not be used any more due to the negative effects on coagulation and its high anaphylactic potency. The historical crystalloid/colloid controversy has been focused primarily on outcome. There is increasing evidence that outcome (mortality) is not the correct measure when assessing the ideal volume replacement strategy. New concepts about critical care such as organ perfusion and organ function, the role of inflammation, immunological aspects, and wound healing may change this point of view. Volume replacement has been hitherto often based on art, dogma and personal beliefs. Further well-performed studies in this area will help more to shed new light on the ideal volume replacement strategy of the hypovolemic patient than more meta-analyses that are pooling old-to-very old studies to solve this problem.

Blood Volume↗
PubMed1983

Distribution and clearance from the body of an oxypolygelatin plasma substitute determined by radioactive tracer study in chimpanzees.

The organ distribution of a colloidal plasma substitute on the basis of oxypolygelatin (Gelifundol S) has been determined in chimpanzees with radioactively tagged material. The radioactivity was distributed uniformly in the whole body and after 24 h it was nearly completely excreted. As liver, spleen, heart, lungs and kidneys were not depicted radiographically in contrast to the body background, it can be concluded that ther e is no preference for the colloid to be stored in any of these organs. Only in the bladder a transiently higher radioactivity could be measured. The urine was collected fo 7 d and contained 91.5% of the colloid originally infused.

Animals↗
PubMed1985

Anaphylactoid reactions to plasma substitutes.

Anaphylactoid reactions have been reported in association with all of the currently available plasma substitutes. The clinical picture ranges from skin reactions only to severe and life-threatening complications, which can be conveniently classified into four grades of severity. The pathomechanism of these anaphylactoid reactions varies for the different colloids. Anti-dextran antibodies (most likely IgG) seem to be responsible for severe DIAR representing an immune complex anaphylaxis. IgE has not been implicated in reactions of this type. Skin tests seem to be of limited value in the diagnosis of dextran reactions and should be performed with great caution. Administration of a specific hapten (low-molecular-weight dextran) prior to dextran infusion reduces the frequency of DIAR in animals and humans. The principal mediator of anaphylactoid reactions due to gelatin infusion is histamine, and this has been established for urea-linked gelatin. It is likely that the diisocyanate present in some polygeline batches is the histamine-releasing substance. Better purification of polygeline and pretreatment with histamine H1-receptor and H2-receptor antagonists have both substantially reduced the frequency of clinical reactions. Changes in plasma complement levels have been observed in patients with anaphylactoid reactions to HES. Antibodies against HES have been detected in humans, but no correlation has been found between the titer of antibodies and anaphylactoid reactions to HES. A further problem with repeated HES infusions is its potentially irreversible storage. Anaphylactoid reactions to colloids should be treated according to the grade of severity. Epinephrine should only be given in severe (grades III and IV) reactions. The early application of glucocorticosteroids (500-1,000 mg of prednisolone equivalent) also may be helpful.

Anaphylaxis↗
PubMed2001

Effects of different plasma substitutes on blood coagulation: a comparative review.

OBJECTIVE: To compare the effects of different colloid plasma substitutes on blood coagulation and postoperative blood loss. DATA SOURCES: Relevant studies were obtained from the medical literature. STUDY SELECTION: Articles were selected that provided data on the effects of colloids on hemostasis and postoperative blood loss in humans. Studies comparing different colloids were looked for using MEDLINE and by searching through the references of studies as they were collected. DATA SYNTHESIS: Articles were reviewed and relevant data were extracted and partly presented in comparative tables. CONCLUSIONS: Dextran, gelatin, and hydroxyethyl starch (HES) all can induce a specific decrease of von Willebrand factor and factor VIII:c. Blood coagulation is most impaired by dextran and high molecular weight HES, both associated with increased postoperative blood loss. The effects of HES on blood coagulation have been shown to depend on its molecular weight and rate of elimination. Detrimental effects have been shown for high molecular weight HES. Medium molecular weight (MMW)-HES with a high degree of substitution (HES 200/0.62) and MMW-HES with high C2/C6 hydroxyethylation ratio (HES 200/0.5/13) are slowly degradable and have been shown to impair blood coagulation after repeated administration. Rapidly degradable HES 200/0.5/6 and gelatin-based plasma expanders appear not to impair hemostasis. However, based on the reviewed literature, all artificial colloids could potentially induce increased bleeding tendency after infusion of very large volumes and especially when given to patients with even mild forms of von Willebrand disease. In those circumstances, crystalloid solutions or alternatives such as plasma or albumin, although associated with other serious complications, could be considered.

Blood Coagulation↗
PubMedDate not supplied

Influence of plasma substitutes on the concentration of tissue catecholamines in rats.

The concentration of catecholamines was determined in the brain, heart and adrenals in normovolaemic and hypovolaemic rats after reinfusion of the lost blood and after infusion of equivalent volumes of plasma substitutes (dextran and modified gelatins). After infusion of these preparations in normovolaemic rats noradrenaline concentration increased significantly in the myocardium. It was found also that restoration of normal blood volume by infusion of plasma substitutes prevented changes in catecholamine concentrations induced by hypovolaemia in the brain but not in the adrenals.

Adrenal Glands↗