PLASMA SUBSTITUTES 



8i 



in shock. The fall in hematocrit and plasma proteins 

 appears to be due principally to hemodilution and 

 not to destruction or impairment of synthesis. How- 

 ever, the prolonged tissue and organ retention of such 

 substances as acacia and PVP militate against their 

 use in human subjects. Dextran, although fairly 

 rapidly excreted and metabolized, suffers from one 

 serious handicap, namely, its tendency to impair 

 hemostasis. This is manifested by a prolongation of 

 the bleeding time, which appears to be related more 

 to an impairment of platelet function than to hemo- 

 dilution or hypervolemia. Thus one hesitates to use 

 dextran in large amounts or in patients suffering 

 from a hemorrhagic defect. Gelatin appears to 

 produce less prolongation of the bleeding time than 

 dextran, and inay, upon further study, prove superior 



in this respect. Dextran, PVP, and gelatin did not 

 alter hepatic function in acute studies. In clinical 

 usage, dextran and gelatin were found to have no 

 deleterious effects upon renal function or urine 

 composition. Although the plasma expanders are 

 potentially antigenic, this does not seem to be a 

 serious contraindication to their clinical or experi- 

 mental use. 



Hemodynamic studies of dextran-infused human 

 subjects and animals have demonstrated that in 

 some instances right atrial pressure and blood volume 

 may be increased without increase of cardiac stroke 

 output. When anemia is produced by dextran in- 

 fusion in bled dogs, cardiac stroke work may be 

 increased without elevation of right atrial transmural 

 pressure. 



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