Transfusion
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The effects of hydroxyethyl starch (HES) on hemostasis were investigated extensively. In order to simulate acute blood loss due to surgery or trauma, one unit (450 ml) of blood was drawn from normal healthy men. This was followed by a 1-liter infusion over 60 minutes of either 6 percent HES, 5 percent albumin, or 0.9 percent sodium chloride (NaCl) as replacement. ⋯ These findings could not be attributed solely to hemodilution. The effects of HES on PTT and factor VIII could not be correlated with plasma HES levels; neither could they be reproduced in vitro by mixing HES with normal plasma. Mean values of the following studies remained normal after infusion of all replacement fluids: prothrombin time, bleeding time, fibrin monomer, fibrin-fibrinogen degradation products, platelet adhesion, circulating platelet aggregates, and platelet count.(ABSTRACT TRUNCATED AT 250 WORDS)
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The effects of hydroxyethyl starch on the final stages of hemostasis were investigated in vivo and in vitro. When compared to control solutions of either 5 percent albumin or isotonic (0.9%) NaCl, 6 percent hydroxyethyl starch (HES) exerted several effects. Results of in vivo studies were as follows: following infusion of 1 liter of 6 percent HES into healthy subjects, fibrinogen and antithrombin-III concentrations fell slightly due to plasma volume expansion and consequent dilution. ⋯ Thus, it would be premature to conclude either that HES or dextran exert identical biological effects on hemostasis or that the two agents possess similar clinical properties. HES has an excellent safety record when it has been used during leukocytapheresis and for plasma volume expansion in recommended doses. Its effects when given in larger doses remain to be defined.
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Studies were conducted to evaluate the characteristics of red cells stored for 35 days following preparation from units of whole blood anticoagulated with citrate-phosphate-dextrose-adenine-one and two (CPDA-1 and CPDA-2) and maintained at 20 to 24 degrees C for 8 hours after phlebotomy. The mean (+/- 1 SD) 24-hour survival for transfused CPDA-1 autologous red cells with hematocrit levels of 78.1 +/- 2.3 percent was 78.0 +/- 8.1 percent (n = 9). The 24-hour survival of red cells from units preserved with CPDA-2 with hematocrit levels of 79.3 +/- 4.5 percent was 74.8 +/- 8.6 percent (n = 15). ⋯ After the initial 8-hour period, the red cell 2,3 diphosphoglycerate levels were 54 +/- 12 percent (mean +/- 1 SD) of initial levels in units drawn into CPDA-1 and 58 +/- 8 percent of initial levels in units drawn into CPDA-2. Following 35 days of storage, units of red cells prepared from whole blood drawn into CPDA-1 and CPDA-2 had comparable plasma cation and ammonia levels and similar amounts of cell-free hemoglobin. These data indicate that red cells can be stored satisfactorily for 35 days when prepared from whole blood held at 20 to 24 degrees C for 8 hours.
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Comparative Study
Characterization of biochemical changes occurring during storage of red cells. Comparative studies with CPD and CPDA-1 anticoagulant-preservative solutions.
Citrate-phosphate-dextrose-adenine (CPDA-1), containing 0.25 mM adenine (final concentration) and 25 percent more glucose than citrate-phosphate-dextrose (CPD), has extended the allowable storage time for red cells to 35 days. Studies were conducted to understand better the characteristics of stored CPDA-1 red cells in relation to the properties of stored CPD red cells. Units with hematocrits near 80 percent showed the following: First, adenosine triphosphate (ATP) and total adenine nucleotide levels of red cells stored with CPDA-1 remained essentially constant during the first 3 weeks of storage after which the levels decreased; with red cells stored with CPD, ATP, and adenine nucleotide, levels were decreased even after 1 week of storage. ⋯ Fourth, hemolysis was much greater in units stored in CPDA-1 for 35 days than in units stored in CPD for 21 days. Fifth, residual glucose concentrations were adequate in units drawn in CPDA-1 and stored for 35 days. We conclude that the changes in the biochemical characteristics of units of red cells stored with CPD and CPDA-1 are similar in most instances with the notable exception of the better maintenance of adenosine triphosphate levels in red cells stored with CPDA-1.
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A case of lichen planus attributed to exposure to hydroxyethyl starch has been reported previously. In this report, a case of lichen planus in a healthy blood donor never exposed to hydroxyethyl starch is presented, the statistical incidence of lichen planus in healthy leukapheresis donors is approximated, and a description of the Koebner phenomenon, which could falsely lead to incorrect conclusions regarding cause and effect in this disease, is discussed.