CHAPTER 5 



Plasma substitutes 



NOBLE O. FOWLER 



Cardiac Laboratory, University of Cincinnati and Cincinnati 

 General Hospital, Cincinnati, Ohio 



CHAPTER CONTENTS 



History 



Requirements of an Acceptable Plctsma Substitute 



Advantages of Colloidal Infusions as Plasma Substitutes 



Properties of Plasma Substitutes 



Fate of Plasma Substitutes on Intravenous Injection 



Polyvinyl Alcohol 



Pectin 



Gelatin 



Polyvinylpyrrolidone ( PVP) 



Dextran 

 Antigenic Properties of Plasma Substitutes 



Pectin 



Bovine Plasma and Albumin 



Globin 



Gelatin 



Polyvinylpyrrolidone 

 Physiologic Effects of Colloidal Infusions in Normal Man and 

 in Animals 



Plasma Volume 



Hemostasis 



Blood Constituents 



Hepatic Function 



Renal Function 



Hemodynamic Effects 

 Physiologic Effects of Colloidal Infusions in Oligemic Animals 

 Clinical Uses and Effects of Plasma Substitutes 

 Summary 



HISTORY 



ONE OF THE EARLIER experimental studies of the 

 intravenous injection of colloids in experimental 

 animals was performed by Czerny (24) in 1894. 

 Czerny injected gum arable or gelatin intravenously 

 into cats, rabbits, and dogs. He observed increased 

 blood viscosity following intravenous injections of 

 gum arabic and a decrease in red blood cell count in 



his experimental animals after the injection of intra- 

 venous colloids. In 191 5, Hogan (50) first used 

 colloidal gelatin intravenously in humans suffering 

 from shock. He noted an improvement in the blood 

 pressure in these patients. In 1918, Bayliss (8) first 

 used 3 or 6 % gum arabic (acacia) in saline in treating 

 wound shock. He observed that many patients in 

 shock responded; those who failed also did not 

 respond to blood. He observed no immediate un- 

 favorable reaction to the intravenous infusion of 

 gum arabic in saline. Early studies of dextran were 

 made by Gronwall & Ingelman (43) in 1945. These 

 authors suggested that dextran be employed in the 

 treatment of shock for the following reasons: its 

 colloidal osmotic pressure is equal to that of the 

 plasma proteins; it is nontoxic and devoid of anti- 

 genic properties; its viscosity is of the same order as 

 that of blood; it is eliminated and not stored in the 

 organs of the body. 



REQUIREMENTS OF AN ACCEPTABLE 

 PLASMA SUBSTITUTE 



There are a number of requirements which must 

 be met before a plasma substitute may be considered 

 acceptable. Some of these requirements were listed 

 by Gropper and co-workers (44). The plasma 

 expander or substitute a) must be able to maintain a 

 satisfactory colloid osmotic pressure; b) must be 

 capable of being manufactured at a constant compo- 

 sition and at reasonable cost; c) must have a viscosity 

 suitable for intravenous injection; d) should be stable 

 on storage and on e.xposure to wide temperature 

 variation; e) must be easily sterilized; /) must be 

 pyrogen free; g) must be ultimately excreted or 



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