To: Anaxagoras who wrote (1077 ) 8/4/1998 9:06:00 PM From: mesaone Read Replies (1) | Respond to of 1432
The correlation between albumin and Hextend is that both albumin solutions (e.g. albumin in normal saline) and other solutions used to replace lost blood volume ("plasma expanders" such as Hextend) are used to treat the same medical conditions (shock, hypovolemia). Therefore if albumin is suddenly found to be unsuitable for this application (which is the conclusion of the authors of the BMJ paper) then the other solutions must be used instead. And since the generic hydroxyethyl starch in normal saline solution (Hespan) is known to cause bleeding problems, this means that Hextend, once approved by the FDA, will be the leading candidate to replace albumin based solutions. Note also that if the problem with the existing albumin solutions is that they are albumin in normal saline (as opposed to albumin in a physiologically balanced electrolyte solution) then the problems causing addtional deaths with albumin may actually be caused by the elecytrolyte imbalance of the carrier solution, and not the albumin proper. If this is the case, then any attempt to reformulate albumin solutions to correct these problems will interfere with BioTime's patents, which cover not only solutions which use hydroxyethyl starch (HES) as the oncotic agent but also solutions containing albumin. Additionally, some think that HES may be better than albumin when treating individuals with damaged, "leaky" capillaries since the HES molecules are physically larger than the albumin molecules and so may help plug up and seal small leaks in the capillary walls, reducing edema. In any case, it is clear that administering today's albumin based solutions caused additional deaths in the studies reviewed in the BMJ paper, and that doctors will be looking for alternatives such as Hextend to use instead. This increases the natural market for Hextend.