Hydroxyethyl starch accentuates von Willebrand's disease

Area of Science:

• Hematology
• Pharmacology

Background:

• Von Willebrand disease is a common inherited bleeding disorder.
• Hydroxyethyl starch (HES) is used as a plasma volume expander.

Observation:

• A healthy individual with undiagnosed mild VWD received intravenous HES.
• Post-infusion monitoring revealed prolonged bleeding time and decreased platelet adhesion.

Findings:

• Plasma levels of factor VIII coagulant activity, factor VIII-related antigen, and factor VIII ristocetin cofactor were reduced.
• These hemostatic abnormalities persisted for several days without overt bleeding.

Implications:

• Screening granulocyte donors for personal or family bleeding histories is crucial.
• Caution is advised when administering HES to patients with subclinical hemostatic defects.