PLASMA SUBSTITUTES 



69 



this accounted for 42 % of the amount administered. 

 Howard and associates (52) showed that the amount 

 of dextran remaining in the plasma was related to 

 molecular size. These authors used Commercial 

 Solvents Corporation dextran. Of that having an 

 average molecular weight of 34,000, very little 

 remained in the plasma 24 hours after 1000 ml had 

 been given intravenously over a period of i liour. Of 

 molecular weight 51,000 dextran, little remained in 

 the plasma after 72 hours. Other fractions of higher 

 molecular weight remained in the plasma in appre- 

 ciable amoimts at 72 hours. Engstrand & Aberg 

 (27) gave 40 ml of dextran intravenously to cats 

 weighing 2.5 kg and found excretion into the gastric 

 juice, the pancreaticoduodenal juice, tnit none in the 

 bile. The total amount excreted in g hours was 28 % 

 of that injected. In three humans, excretion into the 

 gastric juice was found. Bloom & Wilhelmi (13) 

 showed that oral feeding of de.xtran in rat and man 

 led to an increase of blood reducing substance, most 

 of which was fermentable. There was also an increase 

 of liver glycogen in rats. Dextran was capable of 

 being broken down in the intestine to products which 

 yield glucose and glycogen. 



In summary, it may be said that acacia may persist 

 in the liepatic cells for years after intravenous injec- 

 tion. Certain fractions of polyvinyl alcohol are stored 

 in the reticuloendothelial system, and may produce 

 vascular damage. Certain pectin preparations may be 

 stored in the Kupffer cells and splenic pulp; others 

 are not. Gelatin does not appear to produce significant 

 tissue changes, and may be metabolized in part. 

 Polyxinylpyrrolidone which is not excreted in the 

 urine is stored in fixed body phagocytes; it does not 

 appear to be metabolized. The infusion of dextran is 

 associated with minor tissue changes. There is good 

 evidence that dextran is metabolized, and that 93 

 to 95 "n will leave the body within 8 weeks after in- 

 fusion. 



ANTIGENIC PROPERTIES OF PL.^iSMA SUBSTITUTES 



Pectin 



McClure and associates (73) used i '^( pectin with a 

 relative x'iscosity of 2 at 38° C, which was given to 275 

 patients in amounts of 200 to 1600 ml. No toxicity 

 or antigenicitv was seen except for a purpuric rash in 

 2 patients who received over 5000 ml. These patients 

 received daily injections of 1000 ml. 



Bovine Plasma and Albumin 



Wangensteen and associates (106) gave citrated 

 bovine plasma to 66 patients who received 2 to 10 

 ml intravenously. Fifteen per cent of these subjects 

 had reactions; these were mild to moderate in 9 

 instances, but in one patient with asthma, severe 

 dyspnea occurred. State and associates (96) used 

 purified bovine serum albumin, made by precipita- 

 tion with ethanol at 5° C. In 469 injections to 410 

 patients, 12 (2.9%) had immediate reactions and 38 

 (9.2 '^( ) had delayed reactions. The immediate reac- 

 tions were of two types — anaphylactoid with dyspnea, 

 cyanosis, and fall in blood pressure; or pyrogenic, with 

 chills and fever. The delayed reactions took the form 

 of urticaria, erythema, myalgia, and fever, and oc- 

 curred at 1 2 to 24 hours. Twenty-five per cent bovine 

 albumin was effective in treating shock, but was not 

 recommended by the authors because of the persist- 

 ence of reactions and the incapacity caused by the 

 delayed reactions. 



G lull in 



Strumia and associates (99) used modified globin 

 (mol wt 34,000) which was stable in 0.85% saline. 

 Two hundred and ten injections were given intra- 

 venously to 108 humans. The largest single dose was 

 57 g; the largest amount in 24 hours was 60 g. One 

 patient received a total of 192 g. The concentration 

 of the infused globin was 1.8 to 6.8%. There were a 

 few pyrogenic reactions; these were eliminated by 

 biological control. Xo antigenicity was seen following 

 a second injection. 



Gelatin 



Taylor & Waters (102) gave 7% isinglass (fish 

 swim bladder gelatin) in 0.9% saline as a plasma 

 expander. These authors noted a mild sensitization 

 on repeated injections within 2 weeks in some dogs, 

 but not afterwards. This was a.ssumed to be due to 

 contaminating fish protein. Gordon and associates 

 (37), using 8 or 10 "^"t bone gelatin in 0.9% saline, 

 infused dogs with 20 ml per kg body weight at 3 ml 

 per kg per min; no untoward effects were seen upon 

 blood pressure or respiration. Dogs given 40 ml per 

 kg body weight after bleeding did not show antigenic 

 effects on reinjection of 40 ml per kg body weight after 

 9 weeks. Jacobson & Smyth (60) used 5% osseous 

 gelatin in isotonic sodium chloride (Upjohn). These 

 authors gave 56 injections of 450 to 1000 ml each to 45 



