Plasma Substitutes

Christopher Ryan Hoffman, Alexander Huynh, Henry Liu

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Maintaining normovolemia and electrolyte balance is vital to achieve homeostasis. Failure to sustain this results in insufficient organ perfusion and suboptimal organ system function. Whole blood contains red cells, white cells, and platelets (~45% of volume) suspended in blood plasma (~55% of volume). Blood plasma substitutes are clinically deployed to treat acute or chronic hypovolemia. As there is no ideal plasma substitute, many products are available for clinical use. Many natural and synthetic compounds have been developed in attempts to produce and promote such a substitute. This subsequently leaves clinicians with products that possess varied characteristics and side effect profiles. Products’ oncotic and isotonic effect, duration, sequestration, clearance, adverse effects, cost, and storage requirements all need to be recognized and addressed when considering the appropriate solution to administer. Crystalloid solutions are aqueous solutions of mineral salts and other small, water-soluble molecules. Their diverse chemical compositions exert varying tonicity and osmotic pressures when introduced to patient serum. They are inexpensive, widely available, and used conventionally. However, they are not without safety concerns, as crystalloids given in large and/or long-term volumes can sequester into interstitium, exacerbate fluid overload, and accumulate electrolyte. Colloid solutions are larger molecules suspended in a saline or buffered solution. The molecules are naturally occurring or synthetically produced and exert a high oncotic pressure, expanding volume via oncotic drag. Natural colloid is mainly isolated and purified human serum albumin, produced as a resuscitative agent. A wide variety of concentrations are produced, thus the degree of volume expansion demonstrated is dependent on the concentration given. Despite a lengthy production history, albumin products remain expensive. Many studies document albumin administration in many clinical realms. Evidence supports its use in the setting of sepsis but is potentially harmful in patients suffering from burns and traumatic brain injury. Albumin administration is associated with higher incidences of hypersensitivity reactions and coagulation dysfunction. Synthetic colloids (starches, dextrans, and gelatins) have been researched and developed in attempts to produce more effective and economical alternatives to colloid administration. In general, they are more cost-effective and exert strong osmotic pressure. More recent products exhibit improved duration and clearance, with beneficial microcirculatory effects. However, they are all known for markedly increased risks relative to other compounds, including hypersensitivity reactions, coagulation dysfunction, and hepatorenal injury.

Original languageEnglish (US)
Title of host publicationBlood Substitutes and Oxygen Biotherapeutics
PublisherSpringer International Publishing
Pages185-195
Number of pages11
ISBN (Electronic)9783030959753
ISBN (Print)9783030959746
DOIs
StatePublished - Jan 1 2022

All Science Journal Classification (ASJC) codes

  • General Medicine

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