Hetastarch and Dextran

While albumin is the most commonly used colloid, the other available products are not without their own risks and benefits. Hetastarch (various manufacturers) and Volu-ven contain 6% starch and 0.9% NaCl. This product has no oxygen-carrying capacity and is administered intravenously as a plasma expander. Limitations of this product include acquisition cost, hypersensitivity reactions, and bleeding. Dosing should be reduced in the presence of renal dysfunction. Hextend is a comparable plasma expander that contains 6% hetastarch in lactated electrolyte solution. Low-molecular-weight dextran (various manufacturers) and high-molecular-weight dextran (various manufacturers) are polysaccharide plasma expanders. Anaphylactic reactions and prolonged bleeding times have limited the use of these products. Potential mechanisms of colloid solution-induced bleeding include platelet inhibition or possible dilution of clotting factors via infusion of a large volume colloid solution. Although FFP has been used as a volume expander in cases of excessive blood loss (surgery or trauma) and to prevent bleeding in the presence of abnormal coagulation studies, it is now rarely used for volume expansion given risks of anaphylaxis, potential for viral transmission, and increased nosocomial infection rates.

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