BLOOD AND PLASMA

VOLUME
EXPANDERS
presented by: shyamu mandal

When blood is lost, the greatest immediate

need is to stop further blood loss. The second
greatest need is replacing the lost volume.

The remaining red blood cells can still

oxygenate body tissue.

A volume expander is a type of intravenous

therapy that has the function of providing
volume for thecirculatory system. It may be
used for fuid replacement.

These are high molecular weight substances

which exerts colloidal osmotic pressure, and
when infused intravenously retain fuid in the
vascular compartment. They are used to
correct hypovolemia due to loss of plasma or
blood.

uman plasma or reconstituted human

albumin would seem to be the best.

owever, the former carries the ris! of

transmitting serum hepatitis, AI"# etc. and
the latter is expenssive.

Therefore, synthetic colloids are more often

used.
"esirable properties of a palsma
expanders are$
%. #hould exert osmotic pressure comparable
to plasma.
&. #hould remain in circulation and not lea! out
in tissues, or be too rapidly disposed.
'. #hould be pharmacodynamically inert.
(. #hould not be pyrogenic or antigenic.
). #hould not interfere with grouping and cross
matching of blood.
*. #hould be stable, easily sterili+able and cheap.
T,-.# /0 -1A#2A 3/142. .5-A6".7#
There are two main types of volume expanders8
A. 9rystalloids$:9rystalloids are a;ueoussolutionsof mineral salts or
other water:soluble molecules.
The most commonly used crystalloid fuid isnormalsaline, a
solution ofsodium chlorideat <.=> concentration, which is close to the
concentration in the blood ?isotonic@.Ringer's lactateorRinger's
acetateis another isotonic solution often used for large:volume fuid
replacement. A solution of )>dextrosein water, sometimes
called")W, is often used instead if the patient is at ris! for having
lowblood sugaror highsodium. The choice of fuids may also depend
on the chemical properties of the medications being given

9rystalloid solutions

advantaes

no allergic reactions

easily available

low eAect on blood

coagulation

easily mobilised

d!sadvantaes

move ;uic!ly from

blood vessels

no transport capacity
for oxygen
B. 9olloids$: 9olloids contain larger insoluble
molecules, such asgelatin8blooditself is a
colloid.
9ommon colloids used in the medical
context includealbumin, "extran and starch.
9olloid solutions

advantaes

stay longer in blood

vessels

rapid volume
replacement
?molecular weight
dependent@

easily available

d!sadvantaes

allergic reaction
possible

various eAect on
blood coagulation

diCculty in
mobilisation

no transport capacity
for oxygen
42A6 A1B42I6

it is obtained from pooled human plasma8 %<< ml

of &<> human albumin solution is the osmotic
e;uivalent of about (<< ml of fresh fro+en plasma
or D<< ml of whole blood.

it can be used without regard to patientEs blood

group and does not interfare with coagulation.

4nli!e whole blood or plasma, it is free from the

ris! of transmitting serum hepatitis because the
preparation is heat treated.

The &<> solution draws and holds additional fuid

from tissues8 therefor crystslloid solutions must
be infused concurently for optimum beneFt.
4ses$
I. Burns
II. ypovolaemic shoc!
III. ypoproteinaemia
I3. Acute liver failure and dialysis.
".5T7A6

It is polysaccharide obtained from sugar beat

which is available in two forms$

"xtran:G<, molecular weightHG<,<<<

"extran:(<, molecular weightH(<,<<<

The more commonly used preparation is

dextran:G<. it expands plasma volume for nearly
&( hours, and is slowly excreted in glomerular
Fltration as well as oxidised in the boby over
wee!s. #ome amounts is deposited in 7. cells.

"extran has nearly all properties of an ideal

plasma volume expanders except$

It may interfere with blood grouping and cross

matching.

It may trigger anyphylactic reaction.

It can interfere with coagulation and paltelet

function.

"extran:(<, acts more rapidly than dextran:

G<. it reduces the blood viscosity and prevents
7B9 sludging that occurs in shoc!. It rapidly
Fltered at glomerulus, expands plasma volume
for shorter duration.

The total dose should not exceed &<mlI!g in

&( hours.
".J7A"." J.1ATI6
-1,2.7

It is also called as polygeline.

It is a polypeptide with averege 2W '<,<<<,

which exerts osmotic pressure similsr to
albumin and is not allergic, hypersensitivity
reactions are rare, but should be watched for
it.

It is not interfere with grouping and cross

matching of blood and remains stable for '
years.

It is not metaboli+ed in the body, excreted

slowly by the !idneys.

.xpands plasma volume for %& hours.

It is more expensive than dextran.

ypersensitivity reactions li!e fushing, rigor,

urticaria, whee+ing and hypertension can
occur.
,"7/5,.T,1 #TA79

It is a complex mixture of ethoxylated amylopectin

of various molecular si+es8 averege molecular
weight (.) lac?range %<,<<< to % million@.

The colloidal properties of *> .# approximate

those of human albumin. -lasma volume expands
slightly in excess of the volume infused.

aemodynamic status is improved for &( hours or

more.

#maller mplecules?2W K)<,<<<@ are excreted

rapidly by !idney8 (<> of infused dose appears in
urine in &( hours.

Adverse eAects are:

vomiting,

mild fever,

itching, chills,

swelling of salivary glands,

4rticaria.

periorbital oedema.

and bronchospasm.

3oluvenL ?*> hydroxyethyl starch in <.=>

sodium chloride inMection@ is indicated for the
treatment andprophylaxisofhypovolemia. It
is not a substitute forred blood
cellsorcoagulationfactors inplasma.
6/72A1 #1I6.?<.=>
6acl@

9ategory$

Isotonic volume expander.

.lectrolyte replacer.

6ormal #aline is a sterile, nonpyrogenic

solution for fuid and electrolyte
replenishment.

It contains no antimicrobial agents.

The p is ).< ?(.) to G.<@.

It should be used with great care, if at all, in

patients with congestive heart failure, severe
renal insuCciency and in clinical states in which
there exists edema with sodium retention.

#pecial 9onsiderations: Be aware that hypertonic

(1.8%) and hypotonic (0.45%) saline solutions exist. Ensure
appropriate concentration before use.

It contains = gI1 #odium 9hloride with an

osmolarity of '<D m/smolI1.

It contains %)( m.;I1 #odium and 9hloride.

9ontraindications$

#evere ypertension.

-ulmonary edema.
Pre"aut!#ns:

If administering a fuid chec! B- and lung

sounds every &)<cc. "iscontinue bolus if
pulmonary edema is discovered, or once B- is
in therapeutic range ?generally #B- above =<
mmIg@.
7I6J.7 1A9TAT.
#/14TI/6

R!ners La"tate s#lut!#nis a solution that

isisotonicwithbloodand intended
forintravenous administration.

9/2-/#ITI/6$

sodium chloride * gI1

sodium lactate '.% gI1,

potassium chloride<.' gI1,

calcium chloride <.& gI1.

S$DE E%%E&'S:

Abnormal heart rate

Trouble in breathing

Itching

4rticaria

Thrombus formation at the site of in Mection.

Increased fuid volume leading to heart failure.

S'ORA(E:#tore 1actated 7ingerNs solution

at room temperature of &) 9, avoiding
excessive heat. Brief exposure to up to (< 9
does not aAect the product.

1actated 7ingerNs has an osmolarity of &G'

m/smolI1, p of *.), and caloric content of =
!calI1.

PRES&R$BED %OR:1actated 7ingerNs is used

for balancing fuid and electrolytesand as an
al!ali+ing agent.

DOS$N(:Adult dosing of 1actated 7ingerNs

solution is as directed by the physician.
"osing is individuali+ed based on the
patientNs age, weight, ongoing treatment, and
clinical condition.
4#.# /0 -1A#2A 3/142. .5-A6".7#$

The colloidal solutions are used primiraly as

substituents for plasma in conditions where
plasma has been lost or extravascular
compartment8 eg

In burns

ypovolaemic and endotoxin shoc!.

#evere trauma and

.xcessive tissue damage.

9/6T7A I6"I9ATI/6#$

-lasma volume expanders are

contraindicated in$

#evere anaemia,

9ardiac failure,

-ulmonary edema,

7enal insuCciency.
7.0.7.69.#$

Tripathi, O."8 P.ssentials of 2edical

-harmacologyQ8 sixth edition,&<<*8 Raypee
Brothers 2edical -ublicers -vt. 1td. 8 page no$:
*&% to *&'.

7ichard, 0. 8 2ichelle, A. 9. 8 1uigi, 5. 9. 8 P

1ippincottEs Illustrated 7eviews$ -harmacologyQ 8
forth edition,&<%<8 1ippincot Williams and Wi!ins8

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