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Anesth Analg 2007;104:1295-1296
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000260365.95249.fe

LETTER TO THE EDITOR

Section Editor:
Lawrence Saidman

Hemostatic Impairment After Infusion of Hydroxyethyl Starch, Gelatin, and Albumin

Olumuyiwa A. Bamgbade, MD, FRCA, Pema Dorje, MD, and Matthew D. Caldwell, MD

Department of Anesthesiology, University of Michigan Hospital, Ann Arbor, MI, obamgbad{at}umich.edu

To the Editor:

Niemi et al.’s article on hemostatic impairment after infusion of colloids (1) reported that administering gelatin and hydroxyethyl starch after on-pump cardiac surgery impairs fibrin formation and fibrinogen-dependent clot strength. Hydroxyethyl starch caused the greatest impairment, and albumin had the least effect on hemostasis. The coagulation defects caused by hydroxyethyl starch include a decrease of the factor VIII/von Willebrand factor complex (VIII/vWF) and platelet dysfunction, resulting in a type 1 von Willebrand-like syndrome (2). It has been reported that patients with blood group O usually have a significantly lower level of VIII/vWF complex and that the level is further reduced significantly after hydroxyethyl starch administration (3).

It would be very interesting if Niemi et al.’s data were reanalyzed to see if hydroxyethyl starch had any differential coagulopathic effect on ABO blood groups, especially blood group O patients. This important information would help guide the selection of hydroxyethyl starch, gelatin, or albumin in blood group O surgical patients.

REFERENCES

  1. Niemi TT, Suojaranta-Ylinen RT, Kukkonen SI, Kuitunen AH. Gelatin and hydroxyethyl starch, but not albumin, impair hemostasis after cardiac surgery. Anesth Analg 2006;102:998–1006.[Abstract/Free Full Text]
  2. Treib J, Haass A, Pindur G. Coagulation disorders caused by hydroxyethyl starch. Thromb Haemost 1997;78:974–83.[Web of Science][Medline]
  3. Huraux C, Ankri A, Eyraud D, et al. Hemostatic changes in patients receiving hydroxyethyl starch: the influence of ABO blood group. Anesth Analg 2001;92: 1396–401.[Abstract/Free Full Text]



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T. T. Niemi
Hemostatic Impairment After Infusion of Hydroxyethyl Starch, Gelatin, and Albumin
Anesth. Analg., May 1, 2007; 104(5): 1296 - 1296.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2007 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press