Effects of Hydroxyethylstarch (Hespan^R), a Plasma Expander, on the Functional Activity of the Reticuloendothelial System. Comparison with Human Serum Albumin and Pyran Copolymer

Abstract

The purpose of the present investigation was to determine if RES activity was altered after the infusion (bolus i.v. injection over approximately 3-5 min) of hydroxyethylstarch (HES). RES function was determined by vascular clearance of 51Chromium-labeled sheep erythrocytes and the subsequent uptake into the liver, spleen, lungs, and thymus at 1 hr, 3 hr, 6 hr, 1 day, 3 days, and 7 days post infusion. Infusion with the low doses of HES (20 and 40 ml/kg) produced changes in vascular clearance which were comparable to physiological saline. Infusion with 80 ml/kg HES produced a biphasic response with a modest suppression of vascular clearance (i.e., 151% increase in half life) and hepatic phagocytosis (50%) during the first 6 hours after injection, followed by recovery at 24 hours and a stimulation in hepatic uptake (42%) after 3 days. These effects by HES were compared to those produced by infusion with 80 ml/kg HSA, a comparable colloid and with 80 ml/kg pyran copolymer, a positive control.

High doses of hydroxyethyl starch and human albumin have similar effects on monocyte function and oncotic pressure

“…Our results confirm animal studies [5][6][7][8][9] showing no detrimental effect of HES on monocyte/macrophage function. Few clinical studies have been conducted.…”

“…Low molecular weight hydroxyethyl starches (LMW-HES) are cheaper than human albumin, show better general tolerability than modified fluid gelatine, and have less marked haemostatic effects than dextran [1]. Experimental studies have shown either an inhibitory effect [4,5] or no effect [6][7][8][9] of HES on monocyte/ macrophage and lymphocyte function. Experimental studies have shown either an inhibitory effect [4,5] or no effect [6][7][8][9] of HES on monocyte/ macrophage and lymphocyte function.…”

Hydroxyethyl starch does not cross the blood-brain or the placental barrier but the perineurium of peripheral nerves in infused animals

“…For example, renal tubules of infused animals revealed abundant swelling while renal function was shown to be regular (Thompson et al 1979). Furthermore, though HES storage is most extensive in macrophages, the mononuclear phagocytic system (MPS) function is not impaired (Shatney and Chandry 1984;White et al 1986). Moreover, some authors stated that the function of the MPS is improved after HES administration (Lenz et al 1986).…”

Resuscitation with polymeric plasma substitutes is permissive for systemic inflammatory response syndrome and sepsis in multiply injured patients: a retrospective cohort study

“…The question of whether polymeric plasma expanders influence the RES was asked in the late 1980s. The application of HES reduced the phagocytic activity of RES; however, the data were unclear and lacked robust statistical analysis [21, 22]. Therefore, a partial immunosuppressive effect for polymeric plasma substitutes must be postulated.…”