Adverse Reactions to Plasma Volume Expanders

Abstract

Plasma volume expanders are effective in the restoration of blood volume. All the available plasma volume expanders may rarely induce anaphylactoid reactions, although such reactions are extremely uncommon in shocked patients. The reactions are caused by different mechanisms depending on the solution, and there is little evidence that IgE antibodies are involved. In addition to these reactions, effects on haemostasis and renal function may occur, and the persistence of hydroxyethyl starch in the body has led to concern about its potential role as a carcinogen, although there is no evidence to suggest that this has occurred.

A randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery

“…8,26,27 Dahlgren et al argued that the modest reduction in incidence of hypotension does not justify the use of an expensive colloid with a possible risk for adverse reactions such as anaphylaxis. 8 Therefore, colloid should perhaps be reserved for cases with expected severe hypotension.…”

Lethal Anaphylactic Reaction to Intravenous Gelatin in the Course of Surgery

“…Epidemiologic data show that their incidence can be evaluated in the range of 0.07%-0.15%. 5 Because of the lack of adverse reaction reports, their incidence could be higher with respect to published data. Gelatin immediate-type allergy has been reported in children after immunization with live attenuated viral vaccines, 6 after use of recombinant human erythropoietin 7 and rectal suppositories 8 ; in most of these cases, specific IgE to gelatin was detected.…”

The involvement of osmolarity in the safety of contrast media

“…The therapeutic administration of fluids aims to expand intravascular, interstitial and intracellular compartments and, in literature, anaphylactoid reactions have been reported with all classes of colloids. These anaphylactoid reactions have an incidence of 0.07%–0.15%, but often such reactions are not reported and therefore misunderstood [40, 41]. Since crystalloid and colloid fluids present different adverse effects, including nephrotoxicity, anticoagulation, acid base disturbance and anaphylactoid reactions, it is important to choose the type of fluid to be administered based on the characteristics of the different types of fluids, their potential effects following administration and the physiologic needs of patients [42].…”