title: Hydroxyethyl starch and granulocyte transfusions: considerations of utility and toxicity profile for patients and donors.
abstract: Hydroxyethyl starch (hetastarch) is a synthetic glucose compound with extensive clinical use as a volume expander. Because of its red blood cell-sedimenting properties, hetastarch plays a major role in preparation of granulocyte products. Recent concerns have been raised about the use of hetastarch in critically ill patients for the development of renal injury and other severe adverse events. In contrast, granulocyte donors receive much less of this compound during collection procedures, and over many years, minimal toxicity has been documented in these individuals. Furthermore, granulocyte products contain very little hetastarch, and ill effects on renal function have not been associated with their administration. This review assesses available information about the toxicity profile of hetastarch in critically ill patients requiring a volume expander as well as granulocyte donors and recipients. Because of the lack of toxicity in these latter two groups, hetastarch should be available for preparation of granulocyte products and their administration.
authors.affiliation: Departments of Pediatrics and Pathology, University of Colorado Denver, The Anschutz Medical Campus, Aurora, Colorado.|The Center for Cancer and Blood Disorders, Transfusion Services, Children's Hospital Colorado, Aurora, Colorado.|Hematology/Oncology and Bone Marrow Transplantation Laboratories, Aurora, Colorado.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Ambruso
mesh_terms: D001782:Blood Donors; D006348:Cardiac Surgical Procedures; D002986:Clinical Trials as Topic; D000075202:Contraindications; D016638:Critical Illness / Q000628:therapy; D004342:Drug Hypersensitivity / Q000209:etiology; D006098:Granulocytes; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000493:pharmacokinetics; D007674:Kidney Diseases / Q000139:chemically induced; D007937:Leukapheresis / Q000379:methods*; D017708:Leukocyte Transfusion / Q000009:adverse effects*; D007964:Leukocytosis / Q000628:therapy; D015201:Meta-Analysis as Topic; D064887:Observational Studies as Topic; D010952:Plasma Substitutes / Q000009:adverse effects* / Q000493:pharmacokinetics; D017410:Practice Guidelines as Topic; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications; D019851:Thrombophilia / Q000139:chemically induced
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes