If you recall, recently an e-Network member asked for feedback about any problems with using "Hextend" Plasma Expander? The member was particularly concerned with reference to possible interference with pre-transfusion testing and transfusion reaction work-ups. The member could not find an answer to this question in the literature or in the Hextend package insert. The member's institution has not as yet had a bad experience with this product, but this member's institution likes to "be prepared".

The following responses were received:

1. One transfusion medicine expert stated that in essence, Hextend is like Hespan -- for which much literature has been published. This respondent pointed out a paper (Transfusion 1982;22:226-228), authored by Daniels MJ, Strauss RG, and Smith-Floss AM. The paper addresses the effects of hydroxyethyl starch on erythrocyte typing and blood crossmatching. In this paper the authors state that venous blood was mixed with varying amounts of 6% hydroxyethyl starch solution in vitro and also blood samples were obtained from leukapheresis donors who had received infusions of hydroxyethyl starch. These specimens were evaluated as to the accuracy of erythrocyte typing, direct antiglobulin-testing, and antibody detection using saline, albumin, low-ionic strength saline and papain. Specimens were stored at 4 degrees C, and testing was repeated at intervals during one week. Moderate difficulties were encountered, due to rouleaux formation, in the interpretation of typing and antibody screening in some samples that contained greater than 30 percent of the hydroxyethyl starch. Rouleaux formation was readily dispersed with saline and could easily be distinguished from true agglutination by microscopic examination. Although the apparent difficulties were not extreme, the authors advised that blood bank personnel should be alerted to the potentially misleading effects of hydroxyethyl starch on test results.

2. However, in spite of the above literature on hetastarch, a second individual, who is noted for his expertise in immunohematology and in blood bank serology, commented that he had not heard of any serological problems relating to Hextend.

3. A third individual (also a recognized expert in the field) commented that he was not sure of problems with pre-transfusion testing or with problems doing blood bank testing (or other lab testing) after using Hextend, but there was at least one report of an anaphylactic reaction with the product.

4. Finally, a Jehovah's Witness commented that the members of his faith are interested in this product, because of its claims as a substitute for hetastarch, without causing coagulation problems.

Editor's Note: The University of Southern California maintains a 'bloodless surgery' program, and has an institutional policy to respect the wishes of Jehovah's Witnesses and others who request NOT to receive blood transfusions. The possible utility of Hextend as a volume expander, to help avoid the need for blood transfusion, will be discussed at several upcoming hospital committee meetings.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator