Non-specific Treatments Flashcards
Evidence AGAINST the use of HES
May not achieve higher volume expansion than crystalloids - and dependent on the integrity of the glycocalyx (so in conditions like sepsis they may not be superior to crystalloids)
May adsorb to glycocalyx and restrict ultrafiltration
May be assoc with AKI in humans (osmotic nephrosis and other mechanisms)
–> study in dogs reported increased NGAL in urine of those getting HES suggestive of tubular damage. another retrospective study reported higher incidence of AKI and non-survival in HES treated dogs
Phagocytosed intracellular HES can persist for up to 18 days in canine kidneys, depending on the dose received
Assoc with impaired coagulation in humans (inactivation of vWF and FVIII, binding plt surface receptors, accelerated fibrin degradation)
A study in dogs after experimentally induced haemorrhage showed a transient hypocoagulable state consistent with dilution. But still caution if already underlying coagulopathy
Risk of fluid overload which may increase risk of mortality
Dogs recieving HES in retrospective studies have a higher mortality rate but this is confounded by retrospective nature and these being potentially sicker dogs,
Evidence
FOR HES use
In dogs with experimental haemorrhagic shock, endothelial glycocalyx shedding, and inflammation were found to be significantly less after tetrastarch compared with the 4-fold volume of isotonic crystalloid
In normovolaemic, healthy dogs, hetastarch led to the highest volume expanding efficiency after 30 minutes (blood volume increase by 140%) compared with hypertonic saline and normal saline, which lasted up to 4 hours.
recent data suggest that tetrastarch may not cause AKI, as measured by several renal biomarkers for AKI and renal histology, when used for volume resuscitation in experimental haemorrhagic shock in healthy non-septic dogs
In dogs with normal clotting function HES did not impair coagulation beyond the expected dilutional effects.
Types of transfusion reaction
Febrile Non-haemolytic
Acute Respiratory - Transfusion associated dyspnoea, TACO, TRALI
Allergic type I hypersensitivity
Haemolytic - acute from mismatch immunogenic reaction. Non-immunologic from chemical/mechanical/osmotic or thermal RBC damage
Delayed serologic reaction (non-haemolytic)
Transfusion transmitted infection
Citrate toxicity/ hypocalcaemia
Hyperammonemia
Hypotenisve
Purpura
