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Global Blood Safety Initiative. Use of plasma substitutes and plasma in developing countries, Geneva, 20-22 March 1989.
[Unpublished] 1989. , 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.
NETWORK. 1992 Aug; 13(1):20-3.Researchers are pursuing 2 approaches to developing a male contraceptive drug. 1 approach centers around suppression of sperm production the other around blocking conception. Researchers are looking at introducing hormonal contraceptives into men's bodies via injections or implants to stop sperm production. Both forms of these possible male contraceptives will not be available for many years, however. A WHO study on testosterone enanthate of men in 7 countries reveals total suppression of sperm production occurred in almost all the Asian men, but only about 60% suppression occurred in other ethnic groups. A current WHO study is examining whether a hormonal contraceptive which is not 100% effective can be useful if it would be more effective than barrier methods. The Population Council is conducting research on 2 capsule implants with 1 capsule releasing luteinizing hormone releasing hormone 13 to halt sperm production while the other releases an androgen to maintain sex drive. Animal tests indicate complete contraception with no side effects. The other possible means of suppressing sperm production is administration of a cottonseed oil extract called gossypol which appears to stop sperm production thereby eliminating the need for concurrent androgen administration. Yet it does cause potassium depletion in some men which can result in arrhythmias. An antifertility vaccine comprises the 2nd approach. Several US researchers are exploring an antifertility vaccine to produce antibodies only to the specialized sperm surface needed to attach to the egg. The 1st antifertility vaccine would probably be in pill form and a woman's contraceptive since it is earlier to target the smaller number of sperm in the oviduct than in the testes.