Hetastarch side effects. Hetastarch (Hespan): Comprehensive Guide to Side Effects, Uses, and Precautions
What are the main uses of Hetastarch. How does Hetastarch work in the body. What are the most common side effects of Hetastarch. Who should avoid taking Hetastarch. How is Hetastarch administered in medical settings. What precautions should be taken when using Hetastarch during pregnancy or breastfeeding. How does Hetastarch interact with other medications.
Understanding Hetastarch: Composition and Mechanism of Action
Hetastarch, also known by its brand name Hespan, is a crucial medication used in emergency medical situations. But what exactly is this substance? Hetastarch is a synthetic colloid derived from natural starch sources. Its primary function is to increase blood plasma volume, which is essential for maintaining proper circulation and oxygen delivery throughout the body.
How does Hetastarch work? When administered intravenously, Hetastarch expands the plasma volume by drawing fluid from the interstitial space into the bloodstream. This action helps to restore and maintain blood pressure in patients experiencing hypovolemia, a condition characterized by decreased blood volume.
The Science Behind Hetastarch’s Efficacy
The efficacy of Hetastarch lies in its molecular structure. It consists of large, branched molecules of amylopectin that have been modified to resist rapid breakdown by the body’s enzymes. This property allows Hetastarch to remain in the circulatory system for an extended period, providing sustained volume expansion.
- Molecular weight: Typically ranges from 200,000 to 450,000 daltons
- Degree of substitution: 0.4 to 0.7
- Half-life in plasma: Approximately 17 hours
Is Hetastarch a blood substitute? No, Hetastarch is not a blood substitute in the traditional sense. It does not carry oxygen or replace lost blood components. Instead, it acts as a volume expander, helping to maintain blood pressure and circulation until more definitive treatments can be administered.
Primary Uses and Indications for Hetastarch
Hetastarch serves a critical role in emergency medicine and critical care settings. Its primary indication is for the treatment and prevention of hypovolemia, a condition where the body’s fluid volume is severely depleted. This can occur in various clinical scenarios:
- Severe trauma with significant blood loss
- Major surgical procedures
- Burn injuries
- Septic shock
- Hemorrhagic shock
When is Hetastarch typically administered? Healthcare providers usually administer Hetastarch in acute situations where rapid volume expansion is necessary to stabilize a patient’s hemodynamic status. It’s often used as a bridge therapy until blood products or other definitive treatments become available.
Off-Label Uses of Hetastarch
While the FDA-approved use of Hetastarch is primarily for hypovolemia, some clinicians have explored its potential in other medical contexts. These off-label uses include:
- Plasma exchange procedures
- Management of ascites in liver disease
- Cardiopulmonary bypass priming
It’s important to note that these off-label uses are not universally accepted and may carry additional risks. Always consult with a healthcare professional regarding the appropriate use of Hetastarch in specific clinical situations.
Dosage and Administration Guidelines for Hetastarch
Proper dosing of Hetastarch is crucial for its safe and effective use. The dosage is typically individualized based on the patient’s clinical condition, body weight, and response to treatment. Healthcare providers carefully calculate the appropriate amount to administer.
Standard Dosing Protocols
What is the typical dosage range for Hetastarch? The usual adult dose ranges from 500 to 1000 mL, infused intravenously over 1 to 2 hours. However, this can vary depending on the severity of the patient’s condition and their individual response to the treatment.
- Initial dose: 500 mL to 1000 mL
- Maximum daily dose: Generally not to exceed 1500 mL/day or 20 mL/kg/day
- Infusion rate: Typically 20-30 mL/minute in acute hemorrhagic shock
How is Hetastarch administered? Hetastarch is given exclusively as an intravenous infusion. It should never be administered intramuscularly or subcutaneously. The infusion rate may be adjusted based on the patient’s hemodynamic response and clinical status.
Special Populations and Dosing Considerations
Certain patient groups may require modified dosing regimens:
- Elderly patients: May require lower doses due to decreased renal function
- Patients with renal impairment: Dose reduction and close monitoring are essential
- Pediatric patients: Dosing is based on weight and clinical condition
Healthcare providers must carefully monitor patients receiving Hetastarch for signs of fluid overload, allergic reactions, or other adverse effects. They may adjust the dosage or discontinue treatment if necessary.
Potential Side Effects and Adverse Reactions of Hetastarch
While Hetastarch can be life-saving in certain situations, it’s not without potential risks. Patients and healthcare providers should be aware of the possible side effects associated with its use. These can range from mild to severe and may require immediate medical attention.
Common Side Effects
What are the most frequently reported side effects of Hetastarch? The most common adverse reactions include:
- Mild itching or skin rash
- Headache
- Muscle pain
- Swollen glands
- Mild flu-like symptoms
These side effects are generally mild and often resolve on their own. However, patients should inform their healthcare provider if these symptoms persist or worsen.
Serious Adverse Reactions
In some cases, Hetastarch can cause more severe reactions that require immediate medical intervention. These include:
- Anaphylaxis or severe allergic reactions
- Coagulation disorders
- Acute kidney injury
- Pulmonary edema
- Congestive heart failure exacerbation
How can patients recognize a severe reaction to Hetastarch? Signs of a serious adverse reaction may include difficulty breathing, chest pain, severe headache, vision changes, unusual bleeding or bruising, and significant swelling. If any of these symptoms occur, immediate medical attention is crucial.
Long-Term Effects and Monitoring
While Hetastarch is typically used for short-term volume expansion, there are concerns about potential long-term effects, particularly on kidney function. Healthcare providers often monitor patients’ renal function closely during and after Hetastarch administration.
What follow-up care is recommended after receiving Hetastarch? Patients may need regular blood tests to check kidney function, coagulation parameters, and electrolyte levels. Long-term follow-up may be necessary for patients who have received multiple or large doses of Hetastarch.
Contraindications and Precautions for Hetastarch Use
Despite its benefits in certain clinical scenarios, Hetastarch is not suitable for all patients. There are specific contraindications and precautions that healthcare providers must consider before administering this medication.
Absolute Contraindications
Hetastarch should not be used in patients with:
- Known hypersensitivity to hydroxyethyl starch or corn products
- Pre-existing coagulation disorders or bleeding tendencies
- Severe renal impairment or patients on dialysis
- Congestive heart failure
- Intracranial bleeding
Why are these conditions contraindications for Hetastarch use? These conditions can significantly increase the risk of serious adverse effects or complications when Hetastarch is administered. For example, patients with coagulation disorders may experience exacerbation of bleeding, while those with severe renal impairment may be at higher risk for acute kidney injury.
Precautions and Special Populations
Certain patient groups require extra caution and close monitoring when receiving Hetastarch:
- Elderly patients
- Patients with liver disease
- Individuals with a history of cardiac or pulmonary disease
- Pregnant women (FDA pregnancy category C)
- Breastfeeding mothers
How should healthcare providers approach Hetastarch use in these populations? For these groups, the potential benefits of Hetastarch must be carefully weighed against the risks. Dose adjustments, more frequent monitoring, and consideration of alternative treatments may be necessary.
Drug Interactions and Compatibility Issues with Hetastarch
Understanding potential drug interactions is crucial for the safe use of Hetastarch. While it’s generally well-tolerated, there are certain medications and substances that can interact with Hetastarch, potentially altering its effectiveness or increasing the risk of side effects.
Known Drug Interactions
What medications are known to interact with Hetastarch? Some of the notable interactions include:
- Anticoagulants (e.g., warfarin, heparin)
- Platelet inhibitors (e.g., aspirin, clopidogrel)
- Certain antibiotics (e.g., cephalosporins, penicillins)
- Diuretics
- ACE inhibitors
These interactions can potentially increase the risk of bleeding, affect kidney function, or alter the volume-expanding effects of Hetastarch. Healthcare providers must carefully review a patient’s medication list before administering Hetastarch.
Compatibility with Other Intravenous Solutions
Hetastarch is often administered in conjunction with other intravenous fluids or medications. Understanding its compatibility is essential for safe administration.
Is Hetastarch compatible with all IV solutions? No, Hetastarch is not universally compatible. It should not be mixed with:
- Blood or blood products
- Solutions containing calcium
- Highly alkaline solutions
- Certain electrolyte solutions
When in doubt, healthcare providers should consult pharmaceutical references or the hospital pharmacy for specific compatibility information.
Monitoring and Follow-Up Care After Hetastarch Administration
Proper monitoring during and after Hetastarch administration is crucial for patient safety and optimal outcomes. Healthcare providers employ various strategies to assess the patient’s response to treatment and detect any potential complications early.
Immediate Post-Administration Monitoring
What parameters are typically monitored after Hetastarch infusion? Healthcare providers usually focus on:
- Vital signs (blood pressure, heart rate, respiratory rate)
- Fluid balance (input/output)
- Signs of allergic reactions or anaphylaxis
- Indications of fluid overload (e.g., pulmonary edema)
- Bleeding tendencies
How long should patients be monitored after receiving Hetastarch? The duration of monitoring depends on the patient’s clinical condition and response to treatment. In many cases, close monitoring continues for several hours after the infusion is complete.
Long-Term Follow-Up and Laboratory Testing
Beyond the immediate post-administration period, patients who have received Hetastarch may require ongoing follow-up care. This often includes:
- Regular assessment of renal function
- Monitoring of coagulation parameters
- Evaluation of electrolyte balance
- Assessment of overall fluid status
The frequency and duration of follow-up care are individualized based on the patient’s specific circumstances, including the amount of Hetastarch received and any pre-existing medical conditions.
What laboratory tests are commonly performed during follow-up? Typical tests include:
- Complete blood count (CBC)
- Serum creatinine and blood urea nitrogen (BUN)
- Prothrombin time (PT) and activated partial thromboplastin time (aPTT)
- Electrolyte panel
These tests help healthcare providers assess the patient’s recovery and detect any delayed adverse effects of Hetastarch administration.
Patient Education and Self-Monitoring
Educating patients about potential delayed effects of Hetastarch is an important aspect of follow-up care. Patients should be instructed to report any unusual symptoms, such as:
- Unexplained bruising or bleeding
- Swelling, especially in the legs or feet
- Shortness of breath
- Changes in urine output
- Persistent fatigue or weakness
By empowering patients with this knowledge, healthcare providers can ensure prompt recognition and management of any delayed complications associated with Hetastarch use.
Hetastarch (Hespan) – Side Effects, Interactions, Uses, Dosage, Warnings
Reviewed:
Hetastarch (hydroxyethyl starch) is made from natural sources of starch. Hetastarch increases the volume of blood plasma that can be lost from bleeding or severe injury. Plasma is needed to circulate red blood cells that deliver oxygen throughout the body.
Hetastarch is used to treat or prevent hypovolemia (decreased blood plasma volume, also called “shock”) that may occur as a result of serious injury, surgery, severe blood loss, burns, or other trauma.
Hetastarch may also be used for purposes not listed in this medication guide.
uses
What is Hetastarch (Hespan) used for?
- Hypovolemia
warnings
What is the most important information I should know about Hetastarch (Hespan)?
You should not receive this medication if you are allergic to hetastarch, or if you have:
- a bleeding or blood clotting disorder;
- kidney disease;
- congestive heart failure; or
- urination problems not caused by hypovolemia (decreased blood plasma volume).
If possible before you receive hetastarch, tell your doctor if you have:
- liver disease;
- a history of heart disease; or
- if you are allergic to corn.
FDA pregnancy category C. It is not known whether hetastarch will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.
It is not known whether hetastarch passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
In an emergency situation it may not be possible to tell your caregivers about your health conditions, or if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medicine.
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Side Effects
What are the side effects of Hetastarch (Hespan)?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Tell your caregivers right away if you have:
- wheezing or gasping for breath, rapid breathing, sweating, and anxiety;
- a light-headed feeling, like you might pass out;
- weak pulse, slow breathing;
- chest pain, fever, chills, cough; or
- easy bruising, unusual bleeding, or any bleeding that will not stop.
Rare but serious side effects may include:
- severe headache, vision or speech problems, mental changes;
- drooping eyelids, loss of feeling in your face, tremors, trouble swallowing; or
- severe skin reaction — fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Hetastarch can harm your kidneys. Call your doctor at once if you have any of these symptoms of kidney damage: swelling, rapid weight gain, unusual tiredness, nausea, vomiting, feeling short of breath, red or pink urine, painful or difficult urination, or little or no urinating.
Common side effects may include:
- mild itching or skin rash;
- mild headache;
- muscle pain; or
- swollen glands, mild flu symptoms.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Pregnancy & Breastfeeding
Can I take Hetastarch (Hespan) if I’m pregnant or breastfeeding?
FDA pregnancy category C. It is not known whether hetastarch will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.
It is not known whether hetastarch passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Interactions
What drugs and food should I avoid while taking Hetastarch (Hespan)?
Follow your doctor’s instructions about any restrictions on food, beverages, or activity.
Dosage Guidelines & Tips
How to take Hetastarch (Hespan)?
Use Hetastarch (Hespan) exactly as directed on the label, or as prescribed by your doctor.
Do not use in larger or smaller amounts or for longer than recommended.
What should I do if I missed a dose of Hetastarch (Hespan)?
Because you will receive hetastarch in a clinical setting, you are not likely to miss a dose.
Overdose Signs
What happens if I overdose on Hetastarch (Hespan)?
Since hetastarch is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.
If you think you or someone else may have overdosed on: Hetastarch (Hespan), call your doctor or the Poison Control center
(800) 222-1222
If someone collapses or isn’t breathing after taking Hetastarch (Hespan), call 911
911
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Drugs A-Z provides drug information from Everyday Health and our partners, as well as ratings from our members, all in one place. Cerner Multum™ provides the data within some of the Overview, Uses, Warnings, Side Effects, Pregnancy, Interactions, Dosage, Overdose, and Images sections.
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Hetastarch Uses, Side Effects & Warnings
Generic name: hetastarch [ HET-a-starch ]
Brand names: Hespan, Hextend
Dosage form: intravenous solution (60 mg/mL-LR; 60 mg/mL-NaCl 0.9%)
Drug class: Plasma expanders
Medically reviewed by Drugs.com on Jul 19, 2022. Written by Cerner Multum.
What is hetastarch?
Hetastarch (hydroxyethyl starch) is made from natural sources of starch. Hetastarch increases the volume of blood plasma that can be lost from bleeding or severe injury. Plasma is needed to circulate red blood cells that deliver oxygen throughout the body.
Hetastarch is used to treat or prevent hypovolemia (decreased blood plasma volume, also called “shock”) that may occur as a result of serious injury, surgery, severe blood loss, burns, or other trauma.
Hetastarch may also be used for purposes not listed in this medication guide.
Warnings
You should not receive this medication if you have a bleeding or blood clotting disorder, congestive heart failure, kidney disease, or urination problems not caused by hypovolemia (decreased blood plasma volume).
Hetastarch can harm your kidneys. Call your doctor at once if you have any of these symptoms of kidney damage: swelling, rapid weight gain, unusual tiredness, nausea, vomiting, feeling short of breath, red or pink urine, painful or difficult urination, or little or no urinating.
Before taking this medicine
You should not receive this medication if you are allergic to hetastarch, or if you have:
a bleeding or blood clotting disorder;
kidney disease;
congestive heart failure; or
urination problems not caused by hypovolemia (decreased blood plasma volume).
If possible before you receive hetastarch, tell your doctor if you have:
FDA pregnancy category C.
It is not known whether hetastarch will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.
It is not known whether hetastarch passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
In an emergency situation it may not be possible to tell your caregivers about your health conditions, or if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received hetastarch.
How is hetastarch given?
Hetastarch is injected into a vein through an IV. A healthcare provider will give you this injection.
Your breathing, blood pressure, oxygen levels, kidney function, and other vital signs will be watched closely while you are receiving hetastarch. Your blood will also need to be tested daily during treatment.
What happens if I miss a dose?
Because you will receive hetastarch in a clinical setting, you are not likely to miss a dose.:max_bytes(150000):strip_icc()/naproxen-what-you-need-to-know-190103-5c5dc8d746e0fb0001849d10.png)
What happens if I overdose?
Since hetastarch is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.
What should I avoid after receiving hetastarch?
Follow your doctor’s instructions about any restrictions on food, beverages, or activity.
Hetastarch side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Tell your caregivers right away if you have:
wheezing or gasping for breath, rapid breathing, sweating, and anxiety;
a light-headed feeling, like you might pass out;
weak pulse, slow breathing;
chest pain, fever, chills, cough; or
easy bruising, unusual bleeding, or any bleeding that will not stop.
Rare but serious side effects may include:
severe headache, vision or speech problems, mental changes;
drooping eyelids, loss of feeling in your face, tremors, trouble swallowing; or
severe skin reaction — fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Hetastarch can harm your kidneys. Call your doctor at once if you have any of these symptoms of kidney damage: swelling, rapid weight gain, unusual tiredness, nausea, vomiting, feeling short of breath, red or pink urine, painful or difficult urination, or little or no urinating.
Common side effects of hetastarch may include:
mild itching or skin rash;
mild headache;
muscle pain; or
swollen glands, mild flu symptoms.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Hetastarch dosing information
Usual Adult Dose for Hypovolemia:
Dosage for Acute Use in Plasma Volume Expansion: 500 to 1000 mL IV
Maintenance dose: Total dosage and rate of infusion depends on the amount of blood or plasma lost and the resultant hemoconcentration.
Maximum dose: Doses more than 1500 mL per day (approximately 20 mL per kg of body weight) are usually not required although higher doses have been used in postoperative and trauma patients with severe blood loss.
Dosage in Leukapheresis: 250 to 700 mL to which citrate anticoagulant has been added and administered to the input line of the centrifugation apparatus at a ratio of 1:8 to 1:13 to venous whole blood.
Comments:
-Hetastarch and citrate should be thoroughly mixed to assure effective anticoagulation.
-Hetastarch admixtures of 500 to 560 mL with citrate concentrations up to 2.5% are compatible for 24 hours at room temperature.
Uses:
-For treatment of hypovolemia when plasma volume expansion is desired
-This drug in leukapheresis improves the harvesting and increasing the yield of granulocytes by centrifugal means
What other drugs will affect hetastarch?
Other drugs may interact with hetastarch, including prescription and over-the-counter medicines, vitamins, and herbal products.
Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.
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Further information
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
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Copyright 1996-2023 Cerner Multum, Inc. Version: 2.02.
12/14/2014 Horses often suffer from circulatory collapse secondary to acute or chronic blood loss, significant hypoalbuminemia, and septic shock. The treatment of these critically ill patients is limited to restoring blood pressure and delivering oxygen to vital organs such as the brain, kidneys, and liver. Commonly used treatments include the administration of crystalloids and colloids. Infusion of large volumes of crystalloids leads to a decrease in oncotic pressure due to their diluting effect, while intravascular hydrostatic pressure temporarily increases. On the contrary, infusion of colloids leads to an increase in plasma oncotic pressure due to the delivery of large osmotically active molecules that are retained in the vascular bed. Therefore, fluid replacement with colloids may lead to greater improvements in cardiovascular status than with crystalloids. NATURAL COLLOID TREATMENT Whole blood transfusion cast red blood cells and compatibility testing (cross-testing for compatibility). Whole blood transfusion is indicated for horses with hematocrit at or below 12% secondary to acute blood loss or hemolysis. Whole blood transfusion is also indicated in patients with a hematocrit less than or equal to 8% due to chronic blood loss or hemolysis. Of course, these figures are not absolute, and the clinical condition of the patient as a whole must be taken into account along with the determination of the presence of blood loss or hemolysis. Whole blood collection Donor whole blood is collected in special sterile plastic bags or sterile glass containers that contain citric acid-dextrose (acid-citrate-dextrose, ACD) or citrate-phosphate-dextrose (Baxter; Deerfield, 111 . Blood Administration Whole blood is filtered prior to use and then infused into the recipient via an aseptic catheter in the jugular vein. Initially (5-10 minutes), the infusion rate should be slow (0.1 ml/kg) to watch for any signs of adverse reactions. They include tachypnea, shortness of breath, restlessness, tachycardia, piloerection (ruffled hair), muscle fasciculations (fibrillar contractions), or sudden collapse. Further, the transfusion rate can be increased to 20 ml/kg/h, but no more. If severe adverse reactions occur, the transfusion should be stopped and epinephrine (0.01-0.02 ml/kg, 1:1000) administered simultaneously with isotonic solutions. If only mild reactions occur, the rate of transfusion can be reduced and corticosteroids or NSAIDs administered. Treatment with blood components The use of concentrated specific components of equine plasma rather than whole blood may be more appropriate for the treatment of granulocyte, platelet or erythrocyte deficiencies. Alternatives to blood component therapy In addition to transfusion for the treatment of granulocyte deficiency (neutropenia), some alternative products are used. These products include hematopoietic growth factors such as canine and bovine recombinant granulocyte colony stimulating factors. In one study, healthy foals treated with bovine granulocyte colony stimulating factor showed an increase in neutrophils without side effects. The second study showed an increase in bone marrow cellularity and increased myeloid activity after administration of recombinant canine granulocyte colony-stimulating factor to foals. The effectiveness of these products is supported by these studies, however, more work is needed to develop a therapeutic approach for horses of all ages. Plasma transfusion Horses suffering from falling intravascular oncotic pressure due to protein deficiency or neonatal foals suffering from passive transmission deficiency are candidates for plasma administration. Foals require 1-2 L (20-40 ml/kg) of plasma to sufficiently raise IgG levels, and adult hypoproteinemic horses (450 kg) require 6-8 L of plasma to raise oncotic pressure. In general, administration of 7 L of equine plasma, which contains 7 g/dL of protein, will result in a 1 g/dL increase in total protein. SYNTHETIC COLLOID INJECTION Synthetic colloids (getastarch, dextran, gelatin, and polymerized hemoglobin) can be used as an alternative to natural colloid administration for the treatment of hypovolemic and hypooncotic conditions in horses. Hetastarch is a synthetic colloid composed predominantly of amylopectin. It is available as a 6% saline solution and is commonly used in horses in circulatory shock and for the treatment of low oncotic pressure secondary to hypoalbuminemia. The recommended dose is 5-15 ml/kg intravenously over 2-3 days. Interestingly, drug infusion does not result in an increase in total refractive serum dry matter, but rather in a decrease caused by dilution of intravascular proteins. The Hetastarch treatment has some advantages over the administration of other colloids.
9006 3 Diagnostic approach to anemia |
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Natural colloids include whole blood, blood components and plasma. Synthetic colloids are hetastarch, dextran, gelatin and polymerized hemoglobin.
Therefore, any necessary subsequent transfusions should be administered with caution if they occur more than 3 days after the first transfusion. 
Conversely, a small cross-reaction combines the donor’s serum and the recipient’s erythrocytes, which are also tested for agglutination. Unfortunately, such testing does not provide information on hemolysing antibodies (hemolysin), which, if present, cause severe hemolysis of transfused RBCs. Testing for hemolysins requires the addition of exogenous complement from rabbit serum to the reaction mixture. Such testing is carried out only in a few laboratories, since rabbit serum requires special handling and storage conditions. Compatibility testing should precede transfusion, however, this is not always possible. In the absence of information on the donor’s blood group, cross-reactivity, or testing for hemolysins, the ideal blood donor is an adult gelding who has tested negative for infectious anemia virus and has never received blood or plasma transfusions. In addition, the first transfusion of whole blood to a cross-tested or never previously administered patient with blood and blood components is generally well tolerated.
In case of bleeding into the body cavity, autotransfusion of blood can be considered if it can be aseptically collected. 
). The desired ratio of ACD to whole blood is approximately 1:10. Depending on individual preference, a sterile glass container may be more suitable for efficient collection of whole blood due to the negative pressure it holds while under vacuum. However, when they fill up, they become heavy; in the event of a fall, all content may be lost. Regardless of the container, blood is collected aseptically through an intravenous catheter or large bore needle attached to an extension system. The determination of the total volume of blood to be collected and transfused depends on the size of the donor and the expected blood loss of the recipient. A medium-sized horse (450 kg) with a hematocrit of 35-40% can produce approximately 20% (8-10 liters for an adult horse) of its blood volume every 30 days. In general, 20-30% of the recipient’s total blood volume (I – 11 L for a 450 kg horse) is sufficient to restore oxygen supply to vital tissues before the bone marrow is able to respond. Alternatively, if whole blood transfusion is warranted and the estimate of blood loss is inaccurate, 15 mL/kg whole blood (6-8 L for a 450 kg horse) may be administered.
Whole blood is best used immediately after collection, but may be stable at 4°C for 2-3 weeks if ACD is added.
This is especially true in patients with cell groups deficient due to cell destruction rather than blood loss. These horses are not deficient in blood volume, but rather deficient in specific constituents. Therefore, transfusion of whole blood to such patients may result in fluid overload, while the administration of individual missing components may be more appropriate. Centrifugal apheresis is a method for concentrating granulocytes, platelets and red blood cells from whole blood. In addition to these cell types, other blood components such as immunoglobulins and clotting factors can be concentrated and applied. Concentrated lyophilized immunoglobulin (Lyphomune, Diagnon Corporation, Rockville, Md.) is commercially available for the treatment of deficient passive transmission in foals, selective immunoglobulin deficiency, and immune-mediated disorders. Cryoprecipitate (a mixture of factor VIII:C, fibrinogen, and fibronectin) is used to treat hemophilia in dogs and humans, but is difficult to obtain or too expensive to use in horses.
The collection of whole blood and the use of blood components should follow the same guidelines as above. In addition, aseptic handling of blood components during centrifugal apheresis is critical to avoid bacterial contamination prior to use.
The use of human recombinant erythropoietin in horses can lead to severe, sometimes fatal anemia.
, Chino, Calif; Immvac, Inc., Columbia, Mo.; Veterinary Immunogenics, LTD, Cumbria, England) or obtained from whole blood that was centrifuged or settled at room temperature for 1-2 hours, followed by removal of erythrocytes settled under gravity. Whole blood collection and plasma administration should be performed as described previously. In addition, aseptic handling of blood components during plasma separation is critical to avoid bacterial contamination prior to administration. Because of the high risk of plasma contamination from large quantities of whole blood, it may be ideal to store liter jars of commercially available equine plasma for future use at 0 0C for up to 1 year. In addition to normal plasma, hyperimmune plasma is commercially available from horses that have been immunized against specific agents responsible for diseases such as rhodococcal pneumonia, salmonellosis, and botulism (Lake Immunogenics, Veterinary Dynamics, Inc., Immvac, Inc., Veterinary Immunogenics , LTD).
The efficacy of these products remains unknown, however, there is evidence that the incidence or severity of rhodococcal pneumonia may be reduced in foals who receive hyperimmune plasma.
Large molecules of the drug are less prone to extravasation through intercellular junctions, thus providing a positive colloidal effect for a long time. Moreover, large molecules can act as plugs to prevent further leakage of albumin into the interstitial space. Hetastarch has been associated with the development of coagulopathy in some animal species, but this is rather a rare complication. 
Unfortunately, the drug has a lifespan of approximately 24 hours and a whole blood transfusion is likely to be required the next day. These drugs are of limited use in horses due to their high cost.Ways to minimize the side effects of antiglaucoma drugs
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- Author: Super User
- Published: 14 March 2019
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UDC 617.7–007.681:546.131:615.038
https://doi.org/10.30702/Ophthalmology.2019/09.105461
Demin Yu.A.1, Dr. med. Sci., Prof., Head of the Department of Ophthalmology
Shebanov R.
V.2, Physician of the Diagnostic Department
1 Kharkov Medical Academy of Postgraduate Education, Kharkov, Ukraine
2 Ophthalmika International Medical Center, Kharkiv, Ukraine
Summary . Medical therapy is the first choice in the treatment of glaucoma. Side effects associated with topical use of drugs can adversely affect the patient’s desire to follow the prescribed treatment (compliance), doctor-patient interaction, and the patient’s quality of life. Benzalkonium chloride (BAC) is the most commonly used preservative currently used in eye drops for the treatment of glaucoma. It is a highly effective antimicrobial preservative, but it also has a toxic effect on cells in various structures of the eye. An alternative to the use of antiglaucoma drops with BAC are other, less toxic preservatives or preservative-free forms of preparations. At the beginning of 2019The first non-preservative antiglaucoma drug from the group of prostaglandin analogues (prostamide) is available in Ukraine – Bimikan® IVF in a multi-dose vial.
The bottle of Bimikan® ECO is equipped with a special dropper patented as the Novelia® system manufactured by Nemera (France).
Keywords : glaucoma, BAC, preservative-free forms, Bimikan® IVF, Novelia® system.
Glaucoma is a group of chronic progressive neuropathies that share common morphological changes in the optic nerve head and in the retinal epithelium, characterized by progressive ganglion cell death and loss of visual fields. Glaucoma is the leading cause of blindness worldwide [1]. The global prevalence of glaucoma among the population aged 40–80 years is 3.54%. In 2013, the number of people aged 40–80 years with glaucoma reached 64.3 million. According to the mathematical model, the number of patients with glaucoma will increase to 76 million by 2020 and to 111.8 million by 2040 [2].
Glaucoma therapy is based on the reduction of intraocular pressure (IOP), which is the most important risk factor in the etiology of glaucomatous optic neuropathy.
Currently, ophthalmologists can offer their patients several treatment options: drug therapy, laser or surgical intervention, the purpose of which is to reduce IOP and prevent or delay visual function loss. It is generally accepted that drug therapy is the method of first choice in the treatment of glaucoma [3]. According to modern ideas about the conservative treatment of glaucoma, when choosing an antihypertensive drug, a number of factors should be taken into account: its effectiveness, the frequency of instillations, cost, impact on general and local hemodynamics, the presence of local and systemic side effects [4]. However, adverse events associated with topical use of drugs can adversely affect the patient’s desire to follow the prescribed treatment (compliance), doctor-patient interaction, and patient quality of life (Figure 1) [3].
In recent years, special attention has been paid to the toxicity of the drug in relation to the surface structures of the eyeball. Most authors associate it with the preservatives that make up the eye drops.
Preservatives under the terms of the pharmacopoeia ensure the stability of ophthalmic solutions and prevent their microbial contamination both during storage and during use of the drug. The severity of the toxic effect depends on the type of preservative, its concentration, the frequency of instillations and the duration of therapy. That is why among patients with glaucoma who are forced to receive antihypertensive drugs for many years, the effect of the preservative on the tear film and epithelial cells of the conjunctiva and cornea becomes especially noticeable [3].
Benzalkonium chloride is the most commonly used preservative currently used in eye drops for the treatment of glaucoma. Its concentration range is from 0.004 to 0.02%. From a chemical point of view, BAC is a quaternary ammonium compound that acts as a cationic detergent. The drug is a highly effective antimicrobial preservative, but it also has a toxic effect on the cells of various eye structures [4].
In vitro studies have shown that even low concentrations of BAC lead to toxic changes and apoptosis of trabecular meshwork cells.
Therefore, theoretically, long-term topical therapy with antiglaucoma drugs that use BAC as a preservative may cause a decrease in trabecular function and a potential worsening of glaucoma. In addition, BAC is involved in the etiology of cataracts. The Ocular Hypertension Treatment Study (OHTS), a large, long-term, prospective, randomized controlled trial, concluded that the incidence of cataracts was higher in eyes treated with preservative-containing topical antiglaucoma drugs. There are certain areas of the eye surface that can be affected by preservatives, causing undesirable side effects: precorneal tear film, cornea, conjunctiva, and tissues of the adnexa of the eye [4].
Figure 1. Unwanted ophthalmic effects of topical drug therapy
Preservatives such as BAC act as detergents [5] by creating a low surface tension by destroying the superficial lipid layer of the precorneal tear film, which leads to a reduction in tear film rupture time, subsequent evaporation of the middle aqueous layer and precipitation of the mucin layer components.
In addition, the toxic effect on the conjunctiva reduces the number and suppresses the function of conjunctival goblet cells, leading to impaired mucin production and subsequent deterioration of corneal epithelium hydration. Therefore, long-term use of eye drops containing BAC as a preservative may cause the development of secondary dry eye syndrome.
The effect of BAC on the cornea has been studied in numerous in vivo studies. It has been proven that even low concentrations of BAC (0.01%) caused the destruction of the epithelial barrier of the cornea [6] and led to a delay in the healing of the cornea, and BAC at a concentration of 0.02% completely suppressed the healing process after keratectomy in the eyes of rabbits [7].
In addition, long-term use of drugs with BAC leads to a decrease in the number of conjunctival goblet cells, disruption of intercellular contacts of corneal epithelial cells with the development of their excessive desquamation, as well as epithelial metaplasia [8].
At the cellular level, BAC induces oxidative stress, causes lysis of cell membranes and protein denaturation, triggering the apoptosis mechanism, activates and maintains the immune-inflammatory response, causing the so-called pro-inflammatory readiness of the conjunctiva and contributing to the development of subconjunctival fibrosis [9]. An alternative to the use of antiglaucoma drops with BAC are other, less toxic preservatives or preservative-free forms of preparations. The European Medicines Agency (EMEA) recommends that preservative-containing antiglaucoma drops be avoided in patients with intolerance.
In today’s practice, physicians and their patients have the choice of topical antiglaucoma drugs that do not contain BAC or other preservatives in monodose dropper bottles, as well as drugs with alternative preservatives – polyquad. However, they are expensive and in some cases inconvenient to use. So far, multi-dose vials that provide long-term sterility have only been available in Ukraine for a range of artificial tears and anti-allergic products: ABAK® patented filtration system, Continuous Single Dose System (COMOD®), Airless Antibacterial Distribution System (AADSTM), and VISMED® Multisystem ./fo-ti-89452_v2-fe7436da48634a728550c78c2ef7a271.png)
Figure 2. Operation of the Novelia® delivery device manufactured by Nemera (France)
At the beginning of 2019, an antiglaucoma drug from the group of prostaglandin analogues (prostamide) – Bimikan® ECO, manufactured by Polpharma (Poland) is available in Ukraine. This is the first and only non-preservative antiglaucoma drug in a multi-dose vial currently available for use by patients in Ukraine. The Bimikan® ECO bottle is equipped with a special dropper, patented as the Novelia® system manufactured by Nemera (France), which provides a three-month sterility due to the dropper with a system of silicone valves acting as a filtering ventilation system, which allows air to enter during use, but prevents penetration microorganisms. In addition, due to the silver coating on the inside, the sterility of the solution inside the vial is maintained (Figure 2).
CONCLUSIONS
Reducing the incidence of local side effects is one of the ways to increase patient adherence to therapy.
A patient who complains of side effects is usually not adherent to therapy, so it is necessary to monitor the condition of the eyelid margins, cornea and conjunctiva during each visit. Particular attention should be paid to glaucoma patients with pre-existing ocular surface lesions or dry eye syndrome [1]. The use of antiglaucoma drugs with alternative preservatives and preservative-free forms of drugs are priority for use as a medical treatment for glaucoma.
Djomin Yu. A.1, Dr. med. Sci., Prof., Head of the Department of Ophthalmology
Shebanov R. V.2, Doctor of Diagnostic Department
1Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
2 International Medical Center “Oftalmika”, Kharkiv, Ukraine
WAYS TO MINIMIZE THE SIDE EFFECTS OF ANTIGLAUCOMA DRUGS
Summary . Drug therapy is the first choice method in treating glaucoma. Side effects associated with medical drug stagnation can cause an unacceptable impact on the patient’s condition, to achieve recognized compliance (compliance), in the relationship between the doctor and the patient and the quality of life of the patient a.
Benzalkonium chloride (BAC) is a preservative that is most often found in ophthalmic drops for the treatment of glaucoma. It is a highly effective antimicrobial preservative, however, it also copes with toxic action on cells of various structures of the eye. An alternative to using antiglaucoma drops with BAC is other, less toxic preservatives or preservative-free formulations. On the cob 2019The first preservative-free antiglaucoma drug from the group of prostaglandin analogues (prostamide) – Bimikan® EKO in a multi-dose vial, has become available in Ukraine. A bottle of Bimican® ECO is provided with a special dropper, patented as the Novelia® system of brewing by Nemera (France).
Key words : glaucoma, BAC, non-preservative forms, Bimican® ECO, Novelia® system.
Demin Yu. A.1, Doctor of Medical Sciences, Prof., Head of the Department of Ophthalmology
Shebanov R.V.2, Physician
1Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
2International Medical Center “Ophtalmica”, Kharkiv, Ukraine
THE WAYS OF MINIMIZATION THE SIDE EFFECTS OF ANTIGLAUCOMA DRUGS
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Drug therapy is the method of first choice in glaucoma. Adverse events, that are associated with local usage of drugs, can have an effect on the patient’s adherence to prescribed treatment, the interaction between the doctor and the patient, and the quality of life. BAC (benzalkonium chloride) is the most commonly used preservative currently used in eye drops for the treatment of glaucoma. BAC is a highly effective antimicrobial preservative, but it also has a toxic effect on the cells of various structural eyes. In vitro studies, even low concentrations of BAH lead to toxic changes and apoptosis of the trabecular apparatus cells. Theoretically, long-term topical therapy with antiglaucoma drugs, in which BAC is used as a preservative, can cause of decreasing of trabecular function and worsening of glaucoma. In addition, prolonged use of drugs with BAC leads to a decrease in the number of cells of the conjunctiva, disruption of the intercellular contacts of epithelial cells of the cornea with the development of their excessive desquamation, as well as epithelial metaplasia.
At the cellular level, BAC induces oxidative stress, causes cell membrane lysis and protein denaturation, triggering the mechanism of apoptosis, activates and maintains the immune-inflammatory response, causing the so-called pro-inflammatory readiness of the conjunctiva and promoting the development of subconjunctival fibrosis. An alternative to antiglaucoma drops with BAC is using other, less toxic preservatives or non-preservative forms of drugs. At the beginning of 2019, the first non-preservative anti-glaucoma preparation from the group of prostaglandin analogues (prostamide), Bimikan ECO in a multi-dose vial, is available in Ukraine. The bottle of Bimikan® ECO is supplied with a special dropper, patented, as the system Novelia® produced by Nemera (France).
Keywords : glaucoma, BAC, non-preservative forms, Bimikan® ECO, Novelia® system.
LIST OF REFERENCES USED
REFERENCES
1. European Glaucoma Society.
Treatment principles and options. Chapter 3. In: EGS. Terminology and guidelines for glaucoma. 4th ed. Savona; 2014. p. 131–90.
2. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis. Ophthalmology. 2014;121(11):2081–90. https://doi.org/10.1016/j.ophtha.2014. 05.013
3. Hopes M, Broadway D. Preservative-free Treatment in Glaucoma is a Sensible and Realistic Aim for the Future. Eur. Ophthalmic Rev. 2010;4:23–8. http://doi.org/10.17925/EOR.2010. 04.01.23
4. Astakhov SYu, Grabovetsky VR, Nefedova DM, Tkachenko NV. Advantages and disadvantages of antihypertensive drops without preservatives. Ophthalmological records. 2011; IV(2):95–7. Astakhov SY, Grabovetskiy VR, Nefedova DM, Tkachenko NV. [Advantages and disadvantages of hypotensive eye drops without preservatives]. Oftalmological vedomosti. 2011;IV(2):95–7. (in Russian).
5. Pisella PJ, Fillacier K, Elena PP, Debbasch C, Baudouin C.