Thrombelastographische Gerinnungsanalyse nach in-vitro- und in-vivo-Hämodilution mit Hydroxyethylstärke (HES)

Abstract

In the study presented the effects of in vitro hemodilution with HES on coagulation are compared with the effects of in vivo hemodilution using thrombelastography (TEG). The in vivo hemodilution was performed by the i. v. infusion of 1000 ml 6 % solution of hydroxyethyl starch HES (2 formulations with HES 130/0.4 and one formulation with HES 200/0.5) in healthy volunteers during 30 min. The in vitro hemodilution was performed with blood samples taken from the volunteers before the infusion was started. These samples were diluted with HES-solution until the same hemoglobin concentration measured at the end of the infusion was attained. The in vivo TEG-parameters remained in the reference range of the method, however all in vitro TEG-parameters are out of the range of normal values. The isolated interpretation of the in vitro data shows an impairment of blood coagulation. The shortening of the reaction time as an indicator for the initiation of blood clotting points to activated coagulation by in vivo hemodilution with HES, whereas in vitro the prolongation of the reaction time is indicative for retardation of clotting. The evaluation of the TEG-parameters and of other clotting parameters determined prior to the beginning of the infusion, at the end of the infusion and four hours after termination of the infusion of HES 130/0.4 and of HES 200/0.5 to healthy volunteers show alterations of blood coagulation parameters caused mainly by dilutional effects. The more pronounced alterations found in vitro cannot be interpreted as impairment of haemostasis in vivo. On the other hand, the likewise haemodilution in vitro causes an impairment of coagulation. Therefore, the effects of in vitro hemodilution with HES on coagulation differ qualitatively and quantitatively from the effects of in vivo hemodilution.

Rapid screening of plasma volume expanders in urine using matrix‐assisted laser desorption/ionisation time‐of‐flight mass spectrometry

“…These conditions, 4 M TFA; 30 min; 100°C, were employed for the analysis of all samples. With these conditions it was anticipated to observe even lower molecular weight distributions for biological samples as these polymers will only be secreted into urine after partial degradation in the liver 5,18–20…”

Hydroxyethyl starch – can the safety problems be ignored?

“…In a crossover study, 7 healthy normovolemic volunteers underwent volume loading with two HES 130/0.4 formulations and HES 200/0.5 [14] All three HES solutions prolonged clot formation time (p < 0.05) and PT (p < 0.05) and diminished maximum clot firmness (p < 0.05), vWF cofactor (p < 0.05) and fibrinogen (p < 0.05).…”

“…Since its molecular weight and proportion of substitution are lower than those of HES 200/0.5 are, HES 130/0.4 might be expected to exhibit shorter intravascular persistence. On the other hand, its C2/C6 ratio of 9.5 is high compared to the ratio of 5 for HES 200/0.5 and would therefore tend to slow clearance [13,14]. As a result of these counterbalancing factors, HES 130/0.4 has been found to be equivalent to HES 200/0.5 with respect to volume expansion, hemodynamic effects, fluid requirements and attained colloid osmotic pressure [13,15,16].…”