No Evidence for the Existence of Preformed Antibodies against Hydroxyethyl Starch in Man

Sirtl, C.; Laubenthal, H.; Scheiner, Otto; Parth, E.; Hj, Dieterich; Szépfalusi, Zsolt; Hj, Trampisch; Gerlach, E.; Peter, K.

doi:10.1159/000129200

Cited by 25 publications

(9 citation statements)

References 17 publications

(26 reference statements)

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“…21, 33-36 The HES method for blood volume estimation is a rapid, safe, and acceptable technique for use in pregnant patients, and does not cross the placenta. 32,33,37,38 …”

Section: Methodsmentioning

confidence: 99%

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

Vricella

Louis

Chien

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective The impact of obesity on maternal blood volume in pregnancy has not been reported. We compared the blood volumes of obese and normal weight gravidas using a validated Hydroxyethyl Starch (HES) dilution technique for blood volume estimation. Study Design Blood volumes were estimated in 30 normal weight (pregravid body mass index; BMI < 25 kg/ m2) and 30 obese (pregravid BMI > 35 kg/m2) gravidas after 34 weeks gestation using a modified HES dilution technique. Blood samples obtained before and 10 minutes after HES injection were analyzed for plasma glucose concentrations after acid hydrolysis of HES. Blood volume was calculated from the difference between glucose concentrations measured in hydrolyzed plasma. Results Obese gravidas had higher pregravid and visit BMI (mean [Std Dev]): pregravid (41[4] vs 22[2] kg/m2, p=0.001); visit BMI (42[4] vs 27[2] kg/m2, p=0.001), but lower weight gain (5[7] vs. 12[4] kg, p=0.001) than normal weight women. Obese gravidas had similar estimated total blood volume to normal weight women (8103 ± 2452 vs. 6944 ± 2830 mL, p = 0.1), but lower blood volume per kilogram weight (73 ± 22 vs. 95 ± 30 mL/kg, p = 0.007). Conclusion Obese gravidas have similar circulating blood volume, but lower blood volume per kilogram body weight, than normal weight gravidas near term.

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“…21, 33-36 The HES method for blood volume estimation is a rapid, safe, and acceptable technique for use in pregnant patients, and does not cross the placenta. 32,33,37,38 …”

Section: Methodsmentioning

confidence: 99%

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

Vricella

Louis

Chien

et al. 2015

American Journal of Obstetrics and Gynecology

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“…In addition to dextran, HES is also used as a colloid solution for volume expansion. Although there are several case reports on HES-induced anaphylactic reactions [ 16 – 19 ], the incidence of such reactions to HES is extremely low compared with dextran [ 9 , 20 , 21 ]. While DRAs are found in most adults, HES-reactive antibodies are extremely rare [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…HES is a synthetic polymer derived from amylopectin, a waxy starch of maze. The reason for the low incidence of antibodies to HES is that the structure of HES resembles that of glycogen [ 20 , 21 ]. Although HES may induce dilution of coagulation factors, HES can be administered instead of dextran in cases where tight hemostasis is completed during operation [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Severe Dextran-Induced Anaphylactic Shock during Induction of Hypertension-Hypervolemia-Hemodilution Therapy following Subarachnoid Hemorrhage

Shiratori¹,

Sato²,

Fukuzawa³

et al. 2015

Case Reports in Critical Care

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Dextran is a colloid effective for volume expansion; however, a possible side effect of its use is anaphylaxis. Dextran-induced anaphylactoid reaction (DIAR) is a rare but severe complication, with a small dose of dextran solution sufficient to induce anaphylaxis. An 86-year-old female who underwent clipping for a ruptured cerebral aneurysm was admitted to the intensive care unit. Prophylactic hypertension-hypervolemia-hemodilution therapy was induced for cerebral vasospasm following a subarachnoid hemorrhage. The patient went into severe shock after administration of dextran for volume expansion, and dextran administration was immediately discontinued. The volume administered at that time was only 0.8 mL at the most. After fluid resuscitation with a crystalloid solution, circulatory status began to recover. However, cerebral vasospasm occurred and the patient's neurological condition deteriorated. Five weeks after the shock, she was diagnosed with hypersensitivity to dextran by a skin test. When severe hypotension occurs after dextran administration, appropriate treatments for shock should be performed immediately with discontinuation of dextran solution. Although colloid administration is recommended in some guidelines and researches, it is necessary to consider concerning the indication for volume expansion as well as the risk of colloid administration.

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“…12,13,15,22,23 Using an enzyme-linked immunosorbent assay, Kraft et al 24 demonstrated absence of anti-HES antibodies in sera from 1,056 patients, concluding that preformed HES-reactive antibodies either do not exist in humans or are extremely rare. Dieterich et al…”

Section: Discussionmentioning

confidence: 99%

Case report: Intraoperative anaphylactoid reaction and hydroxyethyl starch in balanced electrolyte solution (Hextend®)

Hall¹,

Frigas²,

Matešić³

et al. 2006

Can J Anesth/J Can Anesth

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Purpose:To report a first case of probable anaphylactoid reaction to 6% hydroxyethyl starch reconstituted in balanced electrolyte and glucose solution (Hextend ® ). Clinical features:A 22-yr-old man was admitted for a partial nephrectomy. Near the end of the four-hour operation, an infusion of Hextend ® was initiated. Shortly thereafter, mechanical ventilation became difficult, peak inspiratory pressure increased to 55 cm H 2 O with audible wheezing over the patient's lungs. Blood pressure suddenly decreased to 68/46 mmHg. Multiple doses of phenylephrine, ephedrine and epinephrine were required to restore the patient's blood pressure. Postoperatively, a diffuse urticarial rash was apparent on his upper torso. The patient recovered uneventfully. His postoperative serum tryptase was 26.3 ng·mL -1 (reference range, < 11.5 ng·mL -1 ) and the urine N-methyl-histamine was 2448 µg·g -1 creatinine (reference range, 30-200 µg·g -1 creatinine). Two months after the event, skin testing was conducted to test for possible allergy to latex, lidocaine, propofol, cisatracurium, succinylcholine, vecuronium, midazolam, fentanyl, ondansetron, neostigmine, and cephazolin, and all were negative. Hextend ® was also tested, starting with a 1:100,000 dilution and the results were negative. Conclusions:The temporal relationship of severe hypotension, bronchospasm and skin rash within ten minutes from administration of Hextend ® in this patient suggests an immediate hypersensitivity reaction to hetastarch. The elevated levels of serum tryptase and urinary N-methyl-histamine suggest that this hypersensitivity was mediated from mast cell degranulation. Negative skin testing suggests that the reaction was anaphylactoid. Objectif

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No Evidence for the Existence of Preformed Antibodies against Hydroxyethyl Starch in Man

Cited by 25 publications

References 17 publications

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

Severe Dextran-Induced Anaphylactic Shock during Induction of Hypertension-Hypervolemia-Hemodilution Therapy following Subarachnoid Hemorrhage

Case report: Intraoperative anaphylactoid reaction and hydroxyethyl starch in balanced electrolyte solution (Hextend®)

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