Colloid Solution: Dextran-40 is a sterile, clear, non-pyrogenic solution. It is a synthetic plasma volume expander, meaning it is not a blood product but is designed to increase blood volume.
Composition: The 10% injection contains 10 grams of Dextran-40 in every 100 mL, typically suspended in either 0.9% Sodium Chloride (saline) or 5% Dextrose.
Molecular Weight: Dextran-40 is a low molecular weight dextran, with an average molecular weight of approximately 40,000 Daltons. This allows it to improve blood flow in the microcirculation.
Mechanism Focus: The primary action of Dextran-40 is to draw fluid from the interstitial space into the bloodstream, thereby expanding the intravascular volume and enhancing blood flow.
Advantages
Rapid Volume Expansion: Dextran-40 is highly effective at rapidly increasing blood volume, making it a critical tool for treating shock or impending shock.
Improved Microcirculation: Its specific molecular weight and properties help to reduce blood viscosity and inhibit the aggregation of red blood cells and platelets, thereby improving blood flow in the smallest blood vessels.
Prophylaxis of Thromboembolism: It is licensed for use in surgical patients to reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) by its antithrombotic effects on platelets and blood flow.
No Blood Compatibility Issues: As a synthetic colloid, it does not require ABO blood typing or cross-matching, allowing for its immediate use in emergency situations.
Uses
Adjunctive Treatment for Shock: Used as an adjunctive treatment for shock or impending shock due to hemorrhage, burns, trauma, or surgery when whole blood or other blood products are not immediately available.
Prophylaxis of Venous Thromboembolism: Indicated for the prevention of venous thrombosis and pulmonary embolism in patients undergoing high-risk surgical procedures, such as hip surgery.
Extracorporeal Circulation: Employed as a priming fluid in pump oxygenators during extracorporeal circulation (e.g., cardiopulmonary bypass) to maintain circulatory volume and flow.
Microsurgery: Can be used in reconstructive and microvascular surgical procedures to improve blood flow in the microcirculation and reduce the risk of vascular complications.
Nature
Polysaccharide Structure: Dextran is a complex branched polysaccharide composed of linked glucose units. It is produced by the bacterium Leuconostoc mesenteroides.
Pharmacokinetic Profile: The plasma-expanding effect lasts for several hours. Dextran is not metabolized by the body but is excreted by the kidneys, with a portion of the smaller molecules being filtered and excreted rapidly.
Hypertonic Colloid: Dextran-40 is a hypertonic colloid solution, meaning it creates an osmotic gradient that draws water into the blood vessels, leading to a greater expansion in blood volume than the volume of the infused solution.
Interference with Blood Tests: A key characteristic is that it can interfere with certain laboratory tests, including blood typing, cross-matching, and glucose assays, necessitating a pre-infusion blood sample for these tests.
Storage
Room Temperature: Store Dextran-40 Injection 10% at controlled room temperature, typically between 20∘C to 25∘C (68∘F to 77∘F).
Protection: Protect the solution from freezing, which can cause the formation of dextran flakes. If flakes form, the solution can be heated to 100∘C in a water bath until clear, then cooled to body temperature before use.
Discard Unused Portion: The injection contains no bacteriostat or antimicrobial agent, and is intended for single-dose use. Any unused portion must be discarded to prevent contamination.
Visual Inspection: Before use, the solution must be visually inspected. It should be clear and free of particulate matter. Do not use if the solution is discolored or contains particles.
