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[Effects of plasma substitutes on hemostasis]
Y Blanloeil1, M Trossaërt, J C Rigal
1Service d'anesthésie et de réanimation chirurgicale, CHU Nantes Pr R. Souronhg et R. Laënnec, 44093 Nantes, France. yvonnick.blanloeil@chu-nantes.fr
Annales Francaises D'Anesthesie Et De Reanimation
|December 11, 2002
Summary
Isotonic crystalloids are safe for plasma volume replacement, but colloids like hydroxyethyl starch (HES) and dextran can impair hemostasis, especially at higher dilutions. Use caution with colloids in patients with bleeding risks.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Hematology
- Pharmacology
Background:
- Fluid resuscitation is crucial for plasma volume replacement.
- Crystalloids and colloids are commonly used, each with distinct physiological effects.
- Understanding their impact on hemostasis is vital for patient safety.
Purpose of the Study:
- To synthesize data on the hemostatic effects of crystalloids and colloids.
- To evaluate the clinical implications of these effects for plasma volume replacement.
- To compare the hemostatic profiles of various fluid types.
Main Methods:
- Comprehensive literature search of Medline database (1954-2000).
- Inclusion of studies based on methodological quality and publication date.
- Keywords included crystalloids, colloids, specific fluid agents, and hemostasis parameters.
Main Results:
- Crystalloids cause mild hypercoagulability at 10-30% hemodilution; hypocoagulation occurs above 50%.
- Albumin has minimal effect unless hemodilution exceeds 50%.
- Dextran and hydroxyethyl starch (HES) significantly impair hemostasis, affecting platelet function and von Willebrand factor, especially at dilutions over 30%. Gelatin shows moderate effects, potentially potentiated by co-administration with other colloids.
Conclusions:
- All colloids, except isotonic crystalloids, induce hemostatic changes, particularly with >30% hemodilution.
- Hydroxyethyl starch (HES) and dextran exhibit the most pronounced hemostatic effects.
- Careful consideration of fluid type and patient's hemostatic status is essential for safe plasma volume replacement.