Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity.
Hydroxyethyl starch (HES) is reportedly associated with an increased risk of renal failure and death when used for fluid resuscitation in critically ill patients. HES can be used during therapeutic leukocytapheresis (TL) procedures to enhance cell separation. The purpose of this study was to evaluate the occurrence of adverse events associated with HES during TL procedures.



We performed a retrospective review of patients who underwent TL with and without HES in the period 2009 to 2013 at six academic medical institutions.



A difference-in-difference regression analysis was used to estimate the mean change before and after TL in selected outcomes in the HES group relative to the average change in the non-HES group. Selected outcomes included serum creatinine, estimated glomerular filtration rate (eGFR), and white blood cell (WBC) count. A total of 195 patients who underwent 278 TL procedures were studied. We found no significant differences in serum creatinine levels and eGFR on Days 1 and 7 after TL procedure between patients who received and those who did not receive HES. The rate of adverse events and overall and early mortality were similar in both groups. Patients with acute myeloid leukemia who received HES had greater WBC reduction when HES was used. Additionally, patients who received HES had improvement in pulmonary leukostasis symptoms.



HES, used at low doses during TL procedures, was not associated with adverse events previously ascribed to its use as a volume expander.
Department of Laboratory Medicine, University of Washington, Seattle, Washington.
Monica B
MB
Pagano
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Charles
C
Harmon
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Laura
L
Cooling
Division of Hematology, University of Washington, Seattle, Washington.
Laura
L
Connelly-Smith
University of Alabama School of Medicine, Birmingham, Alabama.
Steven A
SA
Mann
Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Huy P
HP
Pham
Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Marisa B
MB
Marques
Department of Pathology, University of Iowa, Iowa City, Iowa.
Annette J
AJ
Schlueter
Division of Transfusion Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Rosemary
R
Case
Division of Transfusion Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Karen E
KE
King
Health Division, IMPAQ International, Columbia, Maryland.
Guido
G
Cataife
Bloodworks Northwest, Seattle, Washington.
Yanyun
Y
Wu
Division of Laboratory Medicine, Departments of Pediatrics and Pathology, Children's National Medical Center, George Washington School of Medicine and Health Sciences, Washington, DC.
Edward C C
EC
Wong
Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
Jeffrey L
0000-0001-8654-3732
JL
Winters
D058186:Acute Kidney Injury / Q000209:etiology*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D007937:Leukapheresis / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D007958:Leukocyte Count; D018921:Leukostasis; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects; D012189:Retrospective Studies
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D003404:Creatinine