Plasma volume expanders

Major blood loss entails the danger of life-threatening circulatory failure, i.e., hypovolemic shock. The immediate threat results not so much from the loss of erythrocytes, i.e oxygen carriers, as from the reduction in volume of circulating blood. 

To eliminate the threat of shock, replenishment of the circulation is essential. With moderate loss of blood, administration of a plasma volume expander may be sufficient Blood plasma consists basically of water, electrolytes, and plasma proteins. However, a plasma substitute need not contain plasma proteins. These can be suitably replaced with macromolecules ( colloids ) that like plasma proteins, (1) do not readily leave the circulation and are poorly filtrable in the renal glomerulus and (2) bind water along with its solutes due to their colloid osmotic properties. In this manner, they will maintain circulatory filling pressure for many hours. On the other hand, volume substitution is only transiently needed and therefore complete elimination of these colloids from the body is clearly desirable. 

Compared with whole blood or plasma, plasma substitutes offer several advantages they can be produced more easily and at lower cost, have a longer shelf life, and are free of pathogens such as hepatitis B or C or AIDS viruses. 

Three colloids are currently employed as plasma volume expanders— the two polysaccharides, dextran and hydroxyethyl starch, as well as the polypeptide, gelatin. 

The most important adverse effect results from the antigenicity of dex-trans, which may lead to an anaphylactic reaction. 

The most important adverse effect results from the antigenicity of dextrans, which may lead to an anaphylactoid reaction. Dextran antibodies can be intercepted without an immune response by injection of small dextran molecules (MW 1000), thus obviating any incompatibility reaction to subsequent infusion of the dextran plasma substitute solution. 

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Hydroxyethylstarch [9005-27-0] has been investigated by hydrodynamic and magnetic spectroscopic methods (128) because of its increasing use as a plasma volume expander. 

Human albumin is a colloid used as a plasma volume expander and is not a source of nutrition. Albumin should be administered separately from PN because it may be incompatible and... 

Plasma Protein Fraction (Plasmanate, Others) [Plasma Volume Expander] Uses Shock 4- BP Action Plasma volume expander Dose Adults. Initial, 250-500 mL IV (not >10 mL/min) subsequent inf... 

HSA Plasma volume expander Human plasma/placenta... 

Table 9.3. Some colloidal plasma volume expanders currently in therapeutic use. In addition to these, albumin and plasma protein fraction may also be used...

Plasma volume expanders and artificial blood substitutes... 

Hetastarch (Hespan) [Plasma Volume Expander] Uses Plasma volume expansion adjunct in shock leukophoresis Action Synthetic colloid acts similar to albumin Dose Volume expansion 500-1000 mL (1500 mL/d max) IV (20 mL/kg/h max rate) Leukapheresis 250-700 mL X- in renal failure Caution [C, +] Contra Severe bleeding disorders, CHF, oliguric/anuric renal failure Disp Inj SE Bleeding (T PT, PTT, bleed time) EMS Observe for anaphylactic Rxns OD Unlikely but may cause fluid overload in susceptible pts... 

Plasma volume expanders such as dextrans may be incompatible at acidic pH.60,70 Care must be exercised with dilutions. Crystals that are formed upon storage may be redissolved by gentle warming. Care must be exercised when preparing doses of recombinant human erythropoietin solution for neonates to maintain the necessary amount of carrier proteins in the formulation 232... 

Specific address information relating to submission of applications for products subject to the licensing provisions of the Public Health Service Act of July 1, 1944, urokinase products, plasma volume expanders, coupled antibodies, and biological products that are also radioactive drugs are described in 21 CFR Part 312.140. 

Between 1945 and 1955, the Northern Regional Research Center (NRRC) of the U. S. Department of Agriculture was extensively involved in the development of the bacterial polysaccharide dextran as a blood-plasma volume-expander. The dextran program was success-... 

Plasma volume expanders. If blood is lost during trauma, the loss of volume is more immediately threatening than the loss of red blood cells. Replacement with salt solutions does not work well because small solutes get rapidly filtrated into the interstitial fluid compartment. Only macromolecules are retained in the intravascular space and can prevent filtration of the diluted plasma due to their osmotic activity. Commonly used plasma expanders are metabolically inert polysaccharides such as dextran and hydroxyethyl-starch. 

Polygeline is a plasma volume expander used as a 3.5% solution with electrolytes in the management of hypovolemic shock. It is also used in extracorporeal perfusion fluids, as a perfusion fluid for isolated organs, as fluid replacement in plasma exchange, and as a carrier solution for insulin. 

Dextran (O Scheme 5) solutions have been used as a plasma volume expander since 1947 owing to their non-immunogenic and well-tolerated nature as plasma substitutes [10]. Furthermore, since dextran suppresses erythrocyte aggregation and reduces blood viscosity, it has... 

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