The use of plasma substitutes with special attention to their side effects

Abstract

Plasma protein fraction and human serum albumin are suitable for plasma replacement; however, they are in short supply and extremely expensive. Fresh-frozen plasma should not be used for volume replacement, but for documented coagulation protein deficiencies and for patients who require massive blood transfusions. Artificial colloids are free from the risk of transmitting diseases and easy to provide at low costs. The intravascular volume effect of colloid solutions based on dextran, gelatin, or hydroxyethyl starch depends on the physicochemical characteristics of the polymer solution. For the given colloid, the half-life varies from 2 to 8 hours. In addition to the volume effect, dextran provides specific antithrombotic properties. None of the colloids are free from the risk of untoward effects, such as anaphylactoid/anaphylactic reactions. The low frequency of these reactions and the possibility to prevent and to treat them justifies the use of artificial colloids on a routine basis for shock treatment, volume support, and perioperative hemodilution.

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

“…Although risk of osmotic nephrosis with gelatines exists [33], the lack of clear clinical data on deleterious effects on renal function [34, 35] is offset by the possible prion transmission, histamine release and coagulopathy [36, 37]. Dextrans have reasonably high volume effects although anaphylaxis, coagulation disorders, osmotic nephrosis and AKI may occur with doses above 1.5 g/kg/day [38–41]. Human albumin (HA) is the only naturally occurring colloid and may appear attractive in hypooncotic hypovolaemia.…”

Cross-linked inulin as a potential plasma expander: Biochemical properties and physiological characterization in a rabbit model

“…A maximum dosage has been prescribed in the use of plasma expanders because of their side effects (Treib, Baron, Grauer, & Strauss, 1999). Moreover, adverse effects, such as pruritus and bleeding, occur frequently after chronic administration of 6% HES and are dose-dependent (Messmer, 1987;Frese et al, 2000). In contrast, 3% CLI2 can reduce the side effects because of its much lower concentration, as reflected by the biopsies of heart, liver, spleen, kidney, lung, and brain of bleeding animals.…”

“…HES is a highly branched amylopectin with ether-linked hydroxyethyl groups and has been extensively studied as a plasma expander. However, HES treated-patients suffer from allergic reactions, bleeding defects and platelet damage (Frese et al, 2000;Messmer, 1987;Schortgen et al, 2001). The side effects of HES depend on the molecular weight (M w ) and its degree of substitutes (DS) (Treib, Baron, Grauer, & Strauss, 1999).…”

Comparative study of isovolemic hemodilution with 3% albumin, dextran-40, and prophylactic enoxaparin (LMWH) on thrombus formation at venous microanastomosis in rats

“…23 In the present study, we used albumin taking into account that it is the most inert colloidal solution with the lowest risk of interference with the hemostasis mechanism in comparison with artificial colloids. 24,25 Thus, our objective was to compare the effects of isovolemic hemodilution per se, with dextran-40 and enoxaparin (0.5 mg/kg/day) in the prevention of microvenous thrombosis using a strong thrombosis model. We intended to establish two factors responsible for thrombogenesis: endothelial damage produced by the execution of the anastomosis itself and blood stasis produced by a stitch that reduced the lumen of the vessel.…”