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    Global Blood Safety Initiative. Use of plasma substitutes and plasma in developing countries, Geneva, 20-22 March 1989.

    League of Red Cross and Red Crescent Societies; World Health Organization [WHO]. Global Programme on AIDS. Health Laboratory Technology Unit

    [Unpublished] 1989. [2], 5 p. (WHO/GPA/INF/89.17; WHO/LAB/89.9)

    Health care practitioners should treat hypovolemia with plasma substitutes rather than plasma since it carries the risk of transmitting infections. They can use plasma to manage hemostasis and sometimes acute plasma protein loss, however. Crystalloid, a plasma substitute, spread swiftly from the capillaries into the interstitial fluid space. Therefore health care practitioners must administer 3 volumes of crystalloid for each volume of blood or plasma lost. This phenomenon may bring about tissue edema which is unacceptable for high risk patients. Another set of substitutes are synthetic colloids which serve to retain circulatory water and volume. They include gelatin solutions, dextran 70, and hydroxyethyl starch (HES). The gelatins function as osmotic diuretics and therefore must be supplemented with 1-2 liters of crystalloid solutions. Dextran and HES draw fluid into the intravascular areas from the surrounding extravascular spaces. Depending on the synthetic colloid, side effects consist of circulatory overload, anaphylactoid reactions, red cell aggregation, platelet and factor VIII interference, and hemostatic interference. Albumin and plasma protein fraction make up the 3rd set of substitutes. Since sophisticated manufacturing techniques and strict quality control are required, they are costly for developing countries to import. They must be pasteurized to inactivate HIV, hepatitis, and other viruses. wpossible side effects are circulatory overload, hypotension, and anaphylactoid reactions. WHO has identified >10 guidelines for managing bleeding, e.g. starting an IV if the pulse rate climbs to >100/minute or systolic blood pressure falls to <90 mm Hg. It also has addressed the need for training for nonphysicians who use plasma substitutes.
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