Elohes administration following an anaphylactoid reaction to Haemaccel.
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Anaphylaxis↗
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Anaphylactic/anaphylactoid reactions to anaesthetic and associated agents. Skin prick tests in aetiological diagnosis.
Fifty-one patients were referred in one year (1992) for investigation of immediate type anaphylactic/anaphylactoid reactions during anaesthesia. Skin prick tests were made with 23 anaesthetic and associated agents in the concentrations used clinically. Definite or probable causes were identified by immediate type wealing reactions, supported by the clinical history in 36 of the 46 in whom a diagnosis of anaphylaxis was made. These comprised mainly the neuromuscular relaxants, chiefly suxamethonium (18); atracurium (6); gallamine (2); one each alcuronium; pancuronium; vecuronium and tubocurarine, as well as alfentanil (1); Gelofusine (2); cefuroxime (1) and latex (2). The materials for performing the skin prick test are readily available and it can be very helpful in making important aetiological diagnoses.
Adjuvants, Anesthesia↗
In-vivo studies on Haemaccel-fibronectin interaction in man.
An enzyme-linked immunoassay has been recently set up for direct measurement of the binding capacity of plasma fibronectin to gelatin. This binding capacity could be completely inhibited in vitro by an eight-fold excess of gelatin, of Haemaccel, but not of Geloplasma. On the contrary, the levels of immunoreactive fibronectin measured by laser nephelometry did not change, in presence of 10 to 1000 micrograms ml-1 of gelatin, of Haemaccel or of Geloplasma. When infused into normal volunteers, Haemaccel provoked a strong and immediate inhibition of the plasma fibronectin binding capacity to gelatin. This inhibition was dose-dependent and maximal after infusion of 500 ml of Haemaccel. Twenty-four hours after this infusion, there was a progressive recovery of the gelatin-binding capacity, which was almost completely achieved 96 h later. The formation of complexes between Haemaccel and fibronectin was demonstrated by gel filtration chromatography and by affinity chromatography. Immunoreactive plasma fibronectin levels remained unchanged up to 24 h after infusion of 500 ml of Haemaccel. A transient decline to 50% of its initial value then occurred the second day after the infusion. Therefore, a delay existed between the formation of fibronectin-Haemaccel complexes and their elimination from the bloodstream. This delay decreased when smaller volumes of Haemaccel were infused, which strongly suggests that plasma fibronectin is cleared by means of Haemaccel and does not seem to play a role of opsonin in these conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
Chromatography, Affinity↗
Cysteinyl leukotriene actions on the microcirculation of the normal and split hydronephrotic rat kidney.
The effects of leukotriene D4 (LTD4) and leukotriene E4 (LTE4) on renal microcirculation were determined on normal and hydronephrotic female Wistar rats. In normal kidneys, the effects of LTD4 on total renal blood flow and glomerular filtration rate were measured by a flow meter and by inulin clearance. In the split hydronephrotic kidney, the LTD4- and LTE4-mediated vascular effects were localized by intravital microscopy. Intravenous infusion of low-dose LTD4 (1 x 10(-9) mol min-1 kg-1) over 15 min induced a strong decrease in renal blood flow (-43% and -70%) in the normal and the hydronephrotic kidney. After the infusion the glomerular filtration rate of the normal kidney was significantly reduced by 65% and the filtration fraction by 32%. The fall in filtration fraction is in accordance with the significant decrease in luminal diameters of the arcuate artery (-28%) and the proximal interlobular artery (-12%) in the hydronephrotic kidney under LTD4. The decrease in renal blood flow, glomerular filtration rate, filtration fraction and luminal diameters persisted in the normal as well as in the hydronephrotic kidney for more than 60 min beyond cessation of infusion. Local application of LTD4 (1 x 10(-10) mol l-1 up to 1 x 10(-7) mol l-1) and LTE4 (1 x 10(-10) mol l-1 up to 1 x 10(-8) mol l-1) induced a dose-dependent constriction of the arcuate artery and the proximal interlobular artery. The distal interlobular artery, the afferent and the efferent arteriole were not significantly affected by LTD4 or LTE4. The glomerular blood flow was dose-dependently reduced up to 48% under local LTD4 and 43% under LTE4. The LTD4/LTE4 antagonist FPL 55712 (1 x 10(-8) mol min-1 kg-1, iv) significantly attenuated the effects of LTD4 infusion and local LTE4 application in the hydronephrotic kidney. This is indicative of the presence of receptors for LTD4 and LTE4 in the larger preglomerular vessels of the rat kidney. The LTD4 effects on the normal kidney were attenuated by simultaneous infusion of dopamine (5 microgram min-1 kg-1) or plasma expansion, two principal methods in the treatment of acute renal failure. The results in the normal and hydronephrotic kidney demonstrate a preferential preglomerular vasoconstriction under LTD4 and LTE4 causing a marked decrease in renal and glomerular blood flow, glomerular filtration rate and filtration fraction.
Animals↗
Colloid osmotic pressure of plasma replacement fluids.
Colloid osmotic pressure (COP) of some of the most frequently used plasma replacement fluids was measured with a colloid osmometer. COP of 4% human albumin solutions was only half that of normal human serum (13.6 +/- 0.6 vs. 27.5 +/- 2.7 mmHg (1.8 +/- 0.1 vs. 3.7 +/- 0.4 kPa)) (mean +/- s.d.), whereas COP of 20% human albumin solutions was eight times higher (196.0 +/- 12.3 mmHg (26.1 +/- 1.6 kPa)). Enhancing the protein concentration from 4% to 20% in the human albumin solutions increased COP 14-fold, reflecting the exponential relationship between protein concentration and COP of a solution. Fresh donor plasma furnished by the hospital blood-bank had a COP about 30% below normal human serum (18.1 +/- 1.3 mmHg (2.4 +/- 0.2 kPa)), due to dilution during preparation. Dextran 70 (6%) had a COP more than twice, and Ringer-Dextran 60 (3%) about 75% of that of normal human serum. Dextran 40 (10%) and gelatin (3.5%, Haemaccel) leaked markedly through the membrane of the colloid osmometer, making acceptable measurements impossible. Seven different hydroxyethyl starch (HES) solutions were measured, and the COP varied between half and 3 times that of normal human serum, depending on molecular weight and concentration of the HES.
Colloids↗
Fluid therapy with Ringer's solution versus Haemaccel following coronary artery bypass surgery.
BACKGROUND: Crystalloid and colloid infusion can be used in volume therapy following heart surgery. In this prospective, randomised study we compared Ringer's solution (group R) to Haemaccel (group H) following coronary artery bypass grafting. METHODS: A stringent protocol for adjusting the infusion rate was used. Haemodynamic parameters and pulmonary function were evaluated as well as chest tube drainage. The double-indicator dilution method was used to measure total blood volume index (TBVI), intrathoracic blood volume index (ITB-VI) and extravascular lung water index (EVLWI). RESULTS: Haemodynamic stability was achieved in both groups throughout the study period, as judged from mean arterial pressure, central venous pressure, pulmonary capillary wedge pressure, and cardiac index. However, the total volume infused was significantly higher in group R. TBVI and ITBV were higher in group H, although only significant at 8 h for TBVI. Pulmonary function was similar in both groups. There was no significant difference in EVLWI, pulmonary shunt fraction, and time on mechanical ventilation. Likewise, chest tube drainage was not significantly different in both groups. CONCLUSION: We conclude that volume therapy with Haemaccel following heart surgery requires less volume and achieves better filling of the circulation compared to Ringer's solution.
Aged↗
A new intact immunoglobulin for intravenous use stabilized by chemically modified gelatin derivatives.
The stabilization of human immunoglobulin (IgG) by chemically modified gelatins (Haemaccel and Gelofusine) was investigated. The gelatins prevented IgG from aggregation induced by exposure to interfaces and lyophilization. The stabilization effects of the gelatins were significantly larger than those of amino acids or sugars. These investigations led to the large-scale production of an immunoglobulin preparation for intravenous use in the clinic. The clinical product meets the Japanese minimum requirements for immunoglobulin preparations for intravenous use, and the long-term preservation of this new freeze-dried preparation has demonstrated its stability.
Amino Acids↗
A comparison of 4.5% human albumin solution and Haemaccel in neonates undergoing major surgery.
In a randomized blinded study we compared two colloid solutions in 30 neonates undergoing major surgery. Fifteen neonates received 4.5% Human albumin solution (HAS) (mean volume 25.6 ml.kg-1, SD 9.5) and the others received Haemaccel (Hoechst) (24.9 ml.kg-1, SD 10). Pre and postoperative plasma albumin and haemoglobin concentrations and plasma colloid osmotic pressure (COP) were compared. In the group given Haemaccel there was an appreciable and statistically significant decrease in the mean plasma albumin concentration from 34.27 to 28.27 g.1(-1) (mean difference 6, CI 3.38 to 8.62) and the mean COP decreased significantly from 22.2 to 19.9 mmHg (mean difference 2.3, CI 0.3 to 4.5). In the HAS group there was no significant change in either the plasma albumin concentration or COP. There was a small but significant decrease in the mean haemoglobin concentration from 15.92 to 14.35 g.dl-1 (mean difference 1.56, CI 0.57 to 2.55) after HAS. We conclude that HAS is the superior colloid for volume replacement in neonates undergoing surgery.
Hemoglobins↗
Haemodynamic changes in gestational proteinuric hypertension: the effects of rapid volume expansion and vasodilator therapy.
Ten patients with gestational proteinuric hypertension were studied with a Swan-Ganz thermodilution haemodynamic catheter before, during and after plasma volume expansion. Five patients were treated with dihydralazine before volume expansion and five after volume expansion. Before treatment all patients had a low pulmonary capillary wedge pressure (PCWP), low cardiac index (CI) and high systemic vascular resistance (SVR). Following volume expansion the PCWP and CI increased, the SVR decreased but the blood pressure (BP) was unchanged. Administration of dihydralazine following volume expansion led to a decrease in PCWP, an increase in CI and a decrease in SVR and BP. Dihydralazine alone caused an increase in heart rate, PCWP, and CI, and a decrease in SVR and BP. Volume expansion, by increasing CI and decreasing SVR, may be of therapeutic benefit in the severely hypertensive pregnant patient with a low cardiac index.
Adult↗
Effects of acute volume changes on P wave characteristics: correlation with echocardiographic findings in healthy men.
INTRODUCTION: This study was performed to determine the effect on the P wave of different hemodynamic loads to the heart. METHODS AND RESULTS: Signal-averaged P wave ECG and atrial echocardiographic measurements were obtained from eight healthy male volunteers at rest and after infusion of 1000 mL of plasma expander (Haemaccel) over 15 minutes. These measurements were repeated 24 hours later at rest and after 0.8 mg of nitroglycerin given sublingually. The effect of positional changes was also studied. At rest the amplitude of the P wave and the time of the maximal the P wave amplitude were reproducible. Sitting increased heart rate variability; no significant changes of the P wave were found. Volume overload decreased the heart rate and increased the atrial size on echocardiography with changes in lead V1 (earlier appearance of the first positive deflection). Nitroglycerin administration increased heart rate and decreased the echocardiographic size of the atria, the latter not reaching statistical significance. Administration of nitroglycerin induced P wave amplitude rise in leads I and II. The maximal power in fast Fourier transformation for calculated orthogonal leads X and Y increased as well. CONCLUSIONS: Amplitude behavior in leads I, II, and V1 appears to correlate with load conditions, particularly with volume redistribution. In healthy men subtle changes in the P wave morphology after volume changes can be detected by the signal-averaged ECG. Application of these findings in patients following acute changes in circulation needs further investigation.
Adult↗
Effects of colloidal resuscitation fluids on reticuloendothelial function and resistance to infection after hemorrhage.
The effects of three resuscitation fluids, hydroxyethyl starch (HES), Haemaccel, and fresh autologous blood, on reticuloendothelial system phagocytic and catabolic functions and resistance to infection after 40% hemorrhages in BALB/c mice were studied. The mice, anesthetized with isoflurane, were bled over a 10-min period, left hypovolemic for 30 min, and then resuscitated with their shed blood or the same volume of asanguineous fluid. Normothermia was maintained throughout the experiments. The uptake and catabolism of intravenously injected double-labelled sheep erythrocytes (51Cr-125I-SRBC) in liver and spleen were determined at 1 and 48 h after hemorrhage. No significant changes in the uptake or catabolism of SRBC in liver or spleen were found at 1 h after hemorrhage and resuscitation with any of the fluids. However, at 48 h a significant increase in liver uptake of SRBC was seen in animals resuscitated with either Haemaccel or HES compared to that in animals resuscitated with shed blood or in animals subjected to a sham operation. The increase in liver uptake was accompanied by a small decrease in spleen uptake in animals resuscitated with Haemaccel but not with HES. No great changes in catabolic activity were seen at 48 h, although activity levels tended to be higher in animals resuscitated with Haemaccel. Separate groups of animals were challenged by an intraperitoneal injection with live Escherichia coli at 1 or 48 h after hemorrhage and resuscitation. Sixty-four percent of the animals resuscitated with shed blood survived the challenge with E. coli at 1 h after hemorrhage, whereas only 10 and 0% survival was seen for animals resuscitated with Haemaccel and HES, respectively. At 48 h survival was 80% for shed-blood-resuscitated animals and 60 and 70% for Haemaccel- and HES-resuscitated animals, respectively.
Animals↗
Letter: Inhibition of ristocetin-induced platelet aggregation by haemaccel.
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Drug Interactions↗
Changes in plasma ionised calcium within 24 hours of trauma in patients infused with the calcium containing colloid Haemaccel during fluid resuscitation.
OBJECTIVE: To determine the changes in ionised plasma calcium levels over a 24 h period in patients sustaining blunt trauma injuries and infused with the calcium containing colloid Haemaccel (6.25 mmol/ litre Ca2+). METHODS: The study was carried out on 24 trauma patients who attended the accident and emergency (A&E) department of the Leicester Royal Infirmary and required fluid resuscitation. Nineteen patients, with a mean injury severity score (ISS) of 14 (range 6 to 36), were given an infusion of Haemaccel; five patients in the control group with an ISS of 12 (range 6 to 19) were infused non-calcium-containing crystalloid. All types of fluids were recorded and serial plasma ionised calcium values were measured over a 24 h period. RESULTS: The mean pre-Haemaccel ionised calcium value fell to 0.71 mmol/litre following trauma. The mean values (mmol/litre) obtained in patients infused with Haemaccel were measured at 2, 4, 8, and 24 h. In the Haemaccel group these values were 1.38 (SD 0.34), 1.40 (0.44), 1.23 (0.27), and 1.18 (0.31) (at least P < 0.001 v baseline). The rise in calcium at 2 h was proportional to the volume of Haemaccel infused (r = 0.917; P < < 0.001). CONCLUSIONS: In all patients the plasma ionised calcium rose on infusion of Haemaccel and in a least one measurement 50% of patients developed hypercalcaemia (Ca2+ < 1.30 mmol/litre). The clinical significance of this is at present unclear.
Adult↗
Does calcium cause the different effects of Gelofusine and Haemaccel on coagulation?
BACKGROUND: Gelofusine (which does not contain calcium) has a greater effect on coagulation than Haemaccel (which contains 6.25 mmol/l of calcium). This in vitro study was performed to assess whether calcium might be the cause of the different effects on coagulation. METHODS: Three solutions were compared; (a) Gelofusine, (b) Gelofusine with calcium added to 6.25 mmol/l, and (c) Haemaccel. Thromboelastography (Sonoclot) was used to examine whole blood coagulation, with time to peak clot weight as the primary outcome measure. RESULTS: There was no significant difference between the Gelofusine containing solutions. Both Gelofusine solutions gave a greater impairment of coagulation than the Haemaccel solution. CONCLUSIONS: The different effect of Gelofusine on coagulation compared with Haemaccel does not seem to be related to the different calcium contents of the solutions.
Blood Coagulation↗
Impairment of coagulation by commonly used resuscitation fluids in human volunteers.
BACKGROUND: This study compared the effects of two commonly used resuscitation fluids on whole blood coagulation. METHODS: 1000 ml of two resuscitation fluids each (saline and Gelofusine) were given to eight volunteers in a crossover design with a 2-week washout period. The effect on whole blood coagulation was assessed using the Sonoclot analyzer, a conventional coagulation screen and coagulation markers. RESULTS: No significant effect was found on whole blood coagulation by giving saline (time to peak clot increased by a mean of 106 s; (95% confidence interval (CI) -140 to 354), whereas Gelofusine delayed the time to peak by a mean of 845 s (95% CI 435 to 1255). By contrast, there was no change in the conventional coagulation screen with either fluid. CONCLUSION: It was concluded that some resuscitation fluids have an effect on clot formation that is not shown by the conventional coagulation screen, but is disclosed only if the whole coagulation process is studied.
Blood Coagulation↗
Skin necrosis following Haemaccel.
Haemaccel is a plasma substitute in frequent clinical use with a low incidence of side effects. I report a patient who developed necrotic blisters following two Haemaccel-insulin infusions, a previously undescribed complication. The rationale behind carrier solutions for insulin therapy is discussed and some of the problems associated with Haemaccel use are considered. I conclude by urging caution in the use of Haemaccel as a carrier solution for insulin therapy.
Humans↗
Influence of acute plasma volume expansion on VO2 kinetics, VO2 peak, and performance during high-intensity cycle exercise.
The purpose of this study was to examine the influence of acute plasma volume expansion (APVE) on oxygen uptake (V(O2)) kinetics, V(O2peak), and time to exhaustion during severe-intensity exercise. Eight recreationally active men performed "step" cycle ergometer exercise tests at a work rate requiring 70% of the difference between the gas-exchange threshold and V(O2max) on three occasions: twice as a "control" (Con) and once after intravenous infusion of a plasma volume expander (Gelofusine; 7 ml/kg body mass). Pulmonary gas exchange was measured breath by breath. APVE resulted in a significant reduction in hemoglobin concentration (preinfusion: 16.0 +/- 1.0 vs. postinfusion: 14.7 +/- 0.8 g/dl; P < 0.001) and hematocrit (preinfusion: 44 +/- 2 vs. postinfusion: 41 +/- 3%; P < 0.01). Despite this reduction in arterial O(2) content, APVE had no effect on V(O2) kinetics (phase II time constant, Con: 33 +/- 15 vs. APVE: 34 +/- 12 s; P = 0.74), and actually resulted in an increased V(O2peak) (Con: 3.90 +/- 0.56 vs. APVE: 4.12 +/- 0.55 l/min; P = 0.006) and time to exhaustion (Con: 365 +/- 58 vs. APVE: 424 +/- 64 s; P = 0.04). The maximum O(2) pulse was also enhanced by the treatment (Con: 21.3 +/- 3.4 vs. APVE: 22.7 +/- 3.4 ml/beat; P = 0.04). In conclusion, APVE does not alter V(O2) kinetics but enhances V(O2peak) and exercise tolerance during high-intensity cycle exercise in young recreationally active subjects.
Adult↗
Processing of human cord blood by three different procedures for red blood cell depletion and mononuclear cell recovery.
BACKGROUND AND OBJECTIVES: Human cord blood (CB) is an important source of stem cells which may be used for hematopoietic reconstitution as an alternative to bone marrow transplantation. Banking of CB would be accomplished by removing red blood cells (RBC) and plasma from CB collections. Our aim was to compare three different procedures for CB processing. MATERIALS AND METHODS: Poligeline, hydroxyethyl starch gel (HES) and gelatin were used as separation media in processing 79 CB units for RBC depletion and mononuclear cell (MNC) recovery. RESULTS: The best MNC recoveries were obtained performing the HES- and the gelatin-based procedures (80.9 and 84.7%, respectively), but the gelatin procedure allowed us to obtain the highest RBC depletion (96.4%); CD34+ cell recovery was higher using HES or gelatin as separation media (85.6 and 85.9%, respectively). CONCLUSION: The best results, as far as RBC removal and MNC recovery are concerned, were obtained by using gelatin as RBC sedimentation medium. Gelatin is a low-cost, animal-derived reagent, which has been successfully used for CB transplantation; the procedure is simple to perform and appears to be suitable for large-scale banking in view of CB transplantation.
Blood Component Removal↗