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Severe Hemodilution With Hydroxyethyl Starch and Dextrans: Effects on Plasma Proteins, Coagulation Factors, and Platelet Adhesiveness

Severe Hemodilution With Hydroxyethyl Starch and Dextrans: Effects on Plasma Proteins,... Abstract DEXTRANS have been in clinical use as plasma expanders for a number of years. Following large infusions, hemorrhage is not infrequent and numerous investigations of the effects of dextrans on blood coagulation factors and hemostatic mechanisms have been made.1-9 One consistent finding has been a prolongation of the bleeding time which seemed out of proportion to the reduction in platelet count. Other findings include reductions in various coagulation factors (which may exceed those anticipated for simple dilution) and an inhibitory effect on the release of platelet thromboplastic factor (platelet factor 3). The experiments performed by Takaori and Safar10,11 offered an opportunity to reexplore the effects of massive infusions of clinical dextran and to compare the effects of dextran 40 and an experimental plasma expander: hydroxyethyl starch (HES). Methods Coagulation factors were measured by previously described methods.12,13 Hematocrit reading and sedimentation rate were measured by Wintrobe's methods.14 References 1. Carbone, J.V., et al: A Hemostatic Defect Associated With Dextran Infusion , Proc Soc Exp Biol 85:101, 1954.Crossref 2. Seegers, W.H.; Levine, W.G.; and Johnson, S.A.: Inhibition of Prothrombin Activation With Dextran , J Appl Physiol 7:617, 1955. 3. Weil, P.G., and Webster, D.R.: Studies on the Bleeding Tendency Following Dextran Infusion , Surg Forum 6:88, 1955. 4. Jacobaeus, U.: The Effect of Dextran on the Coagulation of Blood , Acta Med Scand 151:505, 1955.Crossref 5. Jacobaeus, U.: Studies on the Effect of Dextran on the Coagulation of Blood , Acta Med Scand 322 ( (suppl) ):1, 1957. 6. Langdell, R.D., et al: Dextran and Prolonged Bleeding Time , JAMA 166:346, 1958.Crossref 7. Adelson, E.: Bleeding Time Prolongation After Dextran Infusion , Bibl Haemat 7:275, 1958. 8. Bergentz, S.E.; Eiken, O.; and Nilsson, I.M.: The Effect of Dextran of Various Molecular Weights on the Coagulation in Dogs , Thromb Diath Haemorrh 6:151, 1961. 9. Nilsson, I.M., and Eiken, O.: Further Studies on the Effect of Dextran of Various Molecular Weight on the Coagulation Mechanism , Thromb Diath Haemorrh 11:38, 1964. 10. Takaori, M., and Safar, P.: Treatment of Massive Hemorrhage With Colloid and Crystalloid Solutions, JAMA, to be published. 11. Takaori, M., and Safar, P.: Adaptation to Acute Severe Hemodilution With Dextran 75 in Dogs , Arch Surg 92:743, 1966.Crossref 12. Lewis, J.H.: Coagulation Defects , JAMA 178: 1014, 1961.Crossref 13. Lewis, J.H., and Didisheim, P.: Differential Diagnosis and Treatment in Hemorrhagic Disease , Arch Intern Med 100:157, 1957.Crossref 14. Wintrobe, M.M.: Clinical Hematology , Philadelphia: Lea & Febiger, Publishers, 1956. 15. Salzman, E.W.: Measurement of Platelet Adhesiveness: A Simple in Vitro Technique Demonstrating an Abnormality in von Willebrand's Disease , J Lab Clin Med 62:724, 1963. 16. Ricketts, C.R.: Interaction of Dextran and Fibrinogen , Nature 169:950, 1952.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Severe Hemodilution With Hydroxyethyl Starch and Dextrans: Effects on Plasma Proteins, Coagulation Factors, and Platelet Adhesiveness

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Publisher
American Medical Association
Copyright
Copyright © 1966 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1966.01330060085008
Publisher site
See Article on Publisher Site

Abstract

Abstract DEXTRANS have been in clinical use as plasma expanders for a number of years. Following large infusions, hemorrhage is not infrequent and numerous investigations of the effects of dextrans on blood coagulation factors and hemostatic mechanisms have been made.1-9 One consistent finding has been a prolongation of the bleeding time which seemed out of proportion to the reduction in platelet count. Other findings include reductions in various coagulation factors (which may exceed those anticipated for simple dilution) and an inhibitory effect on the release of platelet thromboplastic factor (platelet factor 3). The experiments performed by Takaori and Safar10,11 offered an opportunity to reexplore the effects of massive infusions of clinical dextran and to compare the effects of dextran 40 and an experimental plasma expander: hydroxyethyl starch (HES). Methods Coagulation factors were measured by previously described methods.12,13 Hematocrit reading and sedimentation rate were measured by Wintrobe's methods.14 References 1. Carbone, J.V., et al: A Hemostatic Defect Associated With Dextran Infusion , Proc Soc Exp Biol 85:101, 1954.Crossref 2. Seegers, W.H.; Levine, W.G.; and Johnson, S.A.: Inhibition of Prothrombin Activation With Dextran , J Appl Physiol 7:617, 1955. 3. Weil, P.G., and Webster, D.R.: Studies on the Bleeding Tendency Following Dextran Infusion , Surg Forum 6:88, 1955. 4. Jacobaeus, U.: The Effect of Dextran on the Coagulation of Blood , Acta Med Scand 151:505, 1955.Crossref 5. Jacobaeus, U.: Studies on the Effect of Dextran on the Coagulation of Blood , Acta Med Scand 322 ( (suppl) ):1, 1957. 6. Langdell, R.D., et al: Dextran and Prolonged Bleeding Time , JAMA 166:346, 1958.Crossref 7. Adelson, E.: Bleeding Time Prolongation After Dextran Infusion , Bibl Haemat 7:275, 1958. 8. Bergentz, S.E.; Eiken, O.; and Nilsson, I.M.: The Effect of Dextran of Various Molecular Weights on the Coagulation in Dogs , Thromb Diath Haemorrh 6:151, 1961. 9. Nilsson, I.M., and Eiken, O.: Further Studies on the Effect of Dextran of Various Molecular Weight on the Coagulation Mechanism , Thromb Diath Haemorrh 11:38, 1964. 10. Takaori, M., and Safar, P.: Treatment of Massive Hemorrhage With Colloid and Crystalloid Solutions, JAMA, to be published. 11. Takaori, M., and Safar, P.: Adaptation to Acute Severe Hemodilution With Dextran 75 in Dogs , Arch Surg 92:743, 1966.Crossref 12. Lewis, J.H.: Coagulation Defects , JAMA 178: 1014, 1961.Crossref 13. Lewis, J.H., and Didisheim, P.: Differential Diagnosis and Treatment in Hemorrhagic Disease , Arch Intern Med 100:157, 1957.Crossref 14. Wintrobe, M.M.: Clinical Hematology , Philadelphia: Lea & Febiger, Publishers, 1956. 15. Salzman, E.W.: Measurement of Platelet Adhesiveness: A Simple in Vitro Technique Demonstrating an Abnormality in von Willebrand's Disease , J Lab Clin Med 62:724, 1963. 16. Ricketts, C.R.: Interaction of Dextran and Fibrinogen , Nature 169:950, 1952.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Dec 1, 1966

References