Review of the Effects of Hydroxyethyl Starch on the Blood Coagulation System

Rg, Strauss

doi:10.1046/j.1537-2995.1981.21381201801.x

Cited by 116 publications

(45 citation statements)

References 11 publications

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“…Prednisone was given orally either as a single dose (50 mg) about 12 h before leukapheresis, or in three divid ed doses (20 mg each) 15, 12 and 2 h before the procedure. suits in serious side-effects, temporary ab normalities in some blood chemistries [12,13], coagulation parameters [23], and plasma volume expansion after multiple transfu sions have been reported [12]. Recent studies have shown that a fraction of the infused HES is eliminated very slowly within the course of 1 year [13,14], generating uncer tainty about the safety of administering HES to leukapheresis donors repetitively.…”

Section: Resultsmentioning

confidence: 99%

A New Method to Collect Granulocytes Using a Low Dose of Hydroxyethyl Starch

Szymanski¹

1983

Vox Sanguinis

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A new granulocyte collection method employing discontinuous flow centrifugation and low donor dose of hydroxyethyl starch (HES) is presented. Following the procedure, the increase in serum polysaccharide concentration was 100 mg/dl, about 20% of that seen after standard discontinuous flow leukapheresis. The average efficiency of granulocyte collection by this method is about 64%. The average yield of WBC from 2,600 ml of donors’ whole blood is 1.64 ± 0.54 x 10^10 (mean ± 1 SD) and the average granulocyte yield is 1.33 ± 0.51 x 10^10 (mean ± 1SD). The granulocytes were shown to migrate to the sites of infection in vivo. This approach is an improvement over standard discontinuous flow leukapheresis because of the high efficiency of granulocyte collection and because multiple procedures are possible without exposing donors to more HES than is currently given during a single procedure.

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Section: Resultsmentioning

confidence: 99%

A New Method to Collect Granulocytes Using a Low Dose of Hydroxyethyl Starch

Szymanski¹

1983

Vox Sanguinis

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“…It has long been known that HES solutions interfere with coagulation 19 and that the effects vary according to the dose and type of solution administered. 20 Solutions with a high molecular weight and a high degree of substitution accumulate in the tissues and are responsible for more pronounced hemostatic effects.…”

Section: Colloidsmentioning

confidence: 99%

Massive transfusion and coagulopathy: pathophysiology and implications for clinical management

Hardy

Moerloose

Samama

2006

Can J Anesth/J Can Anesth

192

108

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Purpose:To review the pathophysiology of coagulopathy in massively transfused, adult and previously hemostatically competent patients in both elective surgical and trauma settings, and to recommend the most appropriate treatment strategies. Methods:Medline was searched for articles on "massive transfusion," "transfusion," "trauma," "surgery," "coagulopathy" and "hemostatic defects." A group of experts reviewed the findings. Principal findings:Coagulopathy will result from hemodilution, hypothermia, the use of fractionated blood products and disseminated intravascular coagulation. The clinical significance of the effects of hydroxyethyl starch solutions on hemostasis remains unclear. Maintaining a normal body temperature is a first-line, effective strategy to improve hemostasis during massive transfusion. Red cells play an important role in coagulation and hematocrits higher than 30% may be required to sustain hemostasis. In elective surgery patients, a decrease in fibrinogen concentration is observed initially while thrombocytopenia is a late occurrence. In trauma patients, tissue trauma, shock, tissue anoxia and hypothermia contribute to the development of disseminated intravascular coagulation and microvascular bleeding. The use of platelets and/or fresh frozen plasma should depend on clinical judgment as well as the results of coagulation testing and should be used mainly to treat a clinical coagulopathy. Conclusions:Coagulopathy associated with massive transfusion remains an important clinical problem. It is an intricate, multifactorial and multicellular event. Treatment strategies include the maintenance of adequate tissue perfusion, the correction of hypothermia and anemia, and the use of hemostatic blood products to correct microvascular bleeding.

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“…It has long been known that HES solutions interfere with coagulation 53 and that the effects vary according to the dose and type of solution administered. 54 Solutions with a high molecular weight and a high degree of substitution accumulate in the tissues and are responsible for more pronounced hemostatic effects.…”

Section: Crystalloids and Colloidsmentioning

confidence: 99%

Massive Transfusion and Coagulopathy

Hardy

Samama

2003

Transfus Alt Transfus Med

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Massive Transfusion and Coagulopathy ) ( Transfusion Alternatives in Transfusion MedicineMost studies of MT have been conducted in trauma patients and are, for obvious reasons, primarily retrospective or uncontrolled observational studies.9 Given the variable and complex clinical context, the results of these studies have seldom led to definitive conclusions. Furthermore, factors other than the transfusion strategy, related to the trauma itself, may have led to the observed hemostatic abnormalities.10 Unfortunately, conventional teaching has sometimes failed to appreciate the evolution of transfusion practices and the context in which these practices were developed. As a result, anesthesiologists may have been led to inappropriately apply transfusion strategies, e.g., those specifically developed for trauma patients at a time when MWB was available, to a patient receiving red cell concentrates for massive bleeding during elective surgery. The situation can become even more confusing when disseminated intravascular coagulation (DIC) is associated with trauma and/or MT.In this article on MT and coagulopathy, we will attempt to do the following:1. Identify the causes of coagulopathy in massively transfused adult and previously hemostatically competent patients in order to determine the most appropriate transfusion/treatment strategies.2. Differentiate between the elective surgical setting and trauma, hypothesizing that recommendations derived from studies of MT in trauma patients may not apply to elective surgical patients.We searched MEDLINE for published articles on massive transfusion, using the search terms "transfusion," "trauma," "surgery," "coagulopathy," and "hemostatic defects." Articles dealing with obstetrical and pediatric patient populations were not retained, nor were those dealing with specific hemostatic anomalies such as cardiopulmonary bypass (CPB), liver transplantation and pre-existing coagulation disorders. A preliminary version of the text was circulated to experts from the (Perioperative Hemostasis Interest Group) for comments and suggestions. A narrative format was adopted given that the heterogeneity of the published studies was too great and not conducive to a more formal review. Since the nature of blood products available to clinicians has changed over time, the retrieved articles were organized and reviewed by date of publication in order to better understand the evolution of our knowledge of MT and coagulopathy. Variables Responsible for Coagulopathy in Association With Massive Transfusion Platelets HemodilutionSince the publication of Miller' s classic study on coagulation defects associated with massive blood transfusions, thrombocytopenia resulting from hemodilution has been thought to be the most important hemostatic abnormality associated with MT.11 This explanation is intuitively appealing: replacement of lost blood with fluids that do not contain platelets (or coagulation factors) results in a dilutional coagulopathy. However appealing the notion, hemodilution fails to explain s...

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Review of the Effects of Hydroxyethyl Starch on the Blood Coagulation System

Cited by 116 publications

References 11 publications

A New Method to Collect Granulocytes Using a Low Dose of Hydroxyethyl Starch

A New Method to Collect Granulocytes Using a Low Dose of Hydroxyethyl Starch

Massive transfusion and coagulopathy: pathophysiology and implications for clinical management

Massive Transfusion and Coagulopathy

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