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HAEMACCEL

Description

Plasma volume expander. Made from polygeline, manufactured from urea-linked bovine gelatin. Also contains:

  1. sodium 145 mmol/L

  2. potassium 5.1 mmol/L

  3. calcium 6.25 mmol/L

  4. chloride 145 mmol/L

  5. pH 7.4 +/− 0.3

  6. osmolarity 301 mOsm/L.

Uses

Colloid plasma volume expander. Plasma half-life about 4 h.

Potential problems

  1. Transfused blood should not be mixed with Haemaccel because it contains calcium. This may result in clotting. Flush Haemaccel out of the IV line before transfusion.

  2. Can cause anaphylaxis.

  3. Can cause increased bradykinin production, leading to hypotension especially in patients taking ACE inhibitors.

  4. There is concern about bovine illnesses being transferred to humans. See Gelofusine.

HAEMATOCRIT (HCT)

Haematocrit is the ratio of the total volume of the red blood cells (RBC) to the total volume of the blood (RBC + plasma) in a blood sample. Normal Hct values are:

  1. males 0.47–0.50

  2. females 0.36–0.48.

The Hct as a percentage can be estimated as 3 × the haemoglobin (Hb) level in g/100 ml. If the Hb is 12, the Hct is 36% or 0.36.

HAEMOCHROMATOSIS

Description

Primary haemochromatosis is an inherited disorder in which too much iron is absorbed from the diet. The iron cannot be excreted and is stored in the liver, heart, pancreas and other parts of the body such as joints. Secondary haemochromatosis is due to a large number of blood transfusions or excess iron in the diet. See Iron overload.

Defect in primary haemochromatosis

A fault in the HFE gene causes primary (or hereditary) haemochromatosis. Normal total body iron in men is 3.5 g and 2.5 g in women. Symptoms may not occur until > 10–20 g has accumulated.

Clinical effects

  1. Systemic symptoms—weakness, lethargy, weight loss.

  2. Skin hyperpigmentation—bronze or grey skin colour.

  3. Liver cirrhosis, hepatocellular carcinoma.

  4. Heart damage/cardiomyopathy.

  5. Pancreatic damage with resulting diabetes mellitus.

  6. Arthritis.

  7. Abdominal pain.

Diagnosis

  1. Elevated serum ferritin, fasting serum iron and transferrin saturation.

  2. Liver biopsy.

  3. Genetic testing for HFE gene mutations.

Treatment

  1. Phlebotomy once or twice per week (500 mL per session). Each session removes 0.25 mg of iron so removal of 10 g of iron requires 40 phlebotomy sessions.

  2. Iron chelation therapy if phlebotomy not an option e.g. anaemia and iron overload. Desferrioxamine is an example of a chelating agent. It acts by binding with iron and enabling its excretion in urine.

  3. Dietary modification—avoid substances which increase iron absorption such as excess alcohol and vitamin C.

  4. Treatment of organ damage such as diabetes mellitus.

  5. Regular screening for hepatocellular carcinoma.

Anaesthesia and ...

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