Hydroxyethyl starch antibodies in humans:: Incidence and clinical relevance

被引:40
作者
Dieterich, HJ
Kraft, D
Sirtl, C
Laubenthal, H
Schimetta, W
Pölz, W
Gerlach, E
Peter, K
机构
[1] Univ Tubingen, Dept Anaesthesiol, D-72076 Tubingen, Germany
[2] Univ Vienna, Inst Gen & Expt Pathol, Vienna, Austria
[3] Ruhr Univ Bochum, St Josef Hosp, Clin Anaesthesiol, D-4630 Bochum, Germany
[4] Johannes Kepler Univ, Inst Syst Sci, A-4040 Linz, Austria
[5] Univ Munich, Dept Physiol, D-8000 Munich, Germany
[6] Univ Munich, Inst Anaesthesiol, Munich, Germany
关键词
D O I
10.1097/00000539-199805000-00041
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Hydroxyethyl starch (HES) is a plasma expander used for perioperative IV fluid management, as well as for resuscitation from trauma and shock. HES is very well tolerated, and the incidence of anaphylactic reactions is lower than with dextran or gelatin. Dextran anaphylaxis is caused by circulating dextran-reactive antibodies (ABs) of the immunoglobin G (IgG) class found in most adults. Histamine release from mast cells induces adverse reactions after gelatin infusion. The cause of adverse reactions due to HES is not yet clear. To inves tigate AB formation due to HES, we collected sera of 1004 patients at least 14 days after starch administration. Using a highly sensitive enzyme-linked immunoabsorbent assay technique, we found one patient with a low 1:10 titer of HES-reactive ABs (immunoglobin M [IgM] class). Despite repeated HES infusions, no clinical reaction could be detected in this patient. On the basis of a binomial distribution, a one-tailed confidence interval (99%) was used to calculate the percentage of the occurrence of ABs in general with maximum of 33 in 10,000 persons (IgM) and 23 in 10,000 persons (IgG). We suggest that HES-reactive ABs are extremely rare and that they do not necessarily induce anaphylaxis. Other mechanisms may be responsible for adverse reactions due to HES. Implications: The frequency of antibody formation due to hydroxyethyl starch, a commonly used plasma expander, was prospectively investigated in 1004 patients. Only one patient showed transient antibody formation, which was not harmful to the patient. This low antigenicity could explain the excellent tolerance of hydroxyethyl starch compared with other plasma expanders.
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页码:1123 / 1126
页数:4
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