Plasma expansion during granulocyte procurement: cumulative effects of hydroxyethyl starch

Abstract

Hydroxyethyl starch (HES) has found widespread use to increase the efficiency of granulocyte collection. Although there is some concern about the possible harmful side effects on the donor, such as plasma expansion, these are believed to be shortlived, since the hematocrit returns to baseline by 24 hr. We have used 131I-albumin to measure the actual changes in plasma volume in donors who received daily doses of 500 ml of HES for 4 consecutive days. All showed marked and progressive increases in plasma volume; the average increase was 40%, with one individual increasing his plasma volume by more than 1 liter. Only 1 donor had returned to normal by the sixth day; the others were still expanded by at least 0.5 liter. Indeed, the HES persisted in the circulation for more than 1 wk. Also, after several days of HES there was an increase in the partial thromboplastin time (PTT). Changes were also noticed in hematocrit, total protein, albumin, and fibrinogen, although platelet aggregation, liver function, and electrolytes did not change. Thus, even in a normal healthy donor the sequential use of HES causes a marked, progressive, and potentially hazardous expansion in the plasma volume, suggesting that repetitive use of a single donor should be cautiously evaluated.