[Comparative study of the efficacy and tolerability of 2 plasma substitutes used as vascular-loading solutions during plasma exchange].

A 4% human albumin solution in association with colloids was tested in an attempt to reduce the cost of replacement fluids during plasma exchange. In a retrospective study, from May 1988 to December 1989, the efficiency and tolerance of gelatin (Plasmion) and dextran 40 (Plasmacair) were compared. Since June 12, 1989, dextran 40 infused only after administration of dextran 1000 (Promit). Seven hundred and forty eight plasma exchanges were performed in 75 patients; 37 received gelatin (7.24 plasma exchanges/patient), 50 dextran (9.6 plasma exchanges/patient) and 12 both solutions after clinical evidence of intolerance to gelatin. No reaction was noted with dextran 40 used alone or in association with haptenic prevention. The gelatin solution induced 2 immediate allergic reactions and one delayed cutaneous reaction. No cross-reactive allergy was observed between the 2 colloids. Dextran 1000 injections were well tolerated. Gelatin infusions were associated with 10 times more episodes of hypovolemia (5.6 versus 0.62%). This difference is probably linked to a faster elimination of gelatin from the vascular compartment and necessitates the infusion of a larger volume of gelatin, as compared to dextran 40, for the same volume of plasma exchanged.