Dextran is a low molecular weight dextran used to assist in the treatment of shock or impending shock due to bleeding, burns, surgery or other trauma, and to prevent venous thrombosis and pulmonary embolism during high-risk medical procedures.
brand name
Bion Tears, Colirio Ocusan, Genteal Tears, Genteal Tears Mild, Tears Naturale, Tears Renewed
background
Dextran is a polysaccharide that is different from other polysaccharides in that its glucose units are linked together by a 1:6 glycosidic bond. The main chain of glucose has frequently spaced short branches, probably connected by 1:3 and 1:4 glycosidic bonds. These chains can be composed of approximately 200,000 glucose units. Many bacteria, such as Leuconostoc, can synthesize dextran from sucrose, and this activity is used commercially to obtain dextran.
Applications of unmodified dextran
plasma expander
Dextran solutions have been used as plasma supplements.
The colloid osmotic pressure of dextran solutions is slightly higher than that of plasma proteins.
If blood volume is insufficient due to trauma or dehydration, dextran may be used to restore blood volume during surgical intervention. If compatibility testing cannot be completed or blood samples need to be tested for pathogens. Dextran is also used to prevent severe postoperative venous thrombosis.
Dextran is also available for ophthalmic applications as a solution or ointment to temporarily relieve dry eye symptoms or minor eye irritation.
Centrifugation/Cell and Organelle Separation
Colloidal solutions containing dextran have been used to separate aggregated platelets, leukocytes, and lymphocytes from blood by centrifugation.
Dextran has been used to isolate intact cell nuclei.
protein precipitation
Dextran has been used to enhance the precipitation and sensitivity of antibody-antigen complexes in immunodiffusion applications.
Inhibit platelet aggregation
Dextran has been reported to have an effect on the hemostatic system, particularly by prolonging bleeding time. In the same trial, dextran was reported to reduce embolism, decrease platelet adhesion, and produce a hemothinning effect. It turns out that these effects increase with increasing dextran molecular weight.
side effect
Although there are relatively few side effects associated with using dextran, these side effects can be serious. These include allergic reactions, volume overload, pulmonary edema, cerebral edema, or platelet dysfunction.
An uncommon but important complication of dextran osmotic effects is acute kidney injury. The pathogenesis of this renal failure is the subject of much debate, with direct toxic effects on the renal tubules and glomeruli combined with high intraluminal viscosity being some of the suggested mechanisms.
Patients with a history of diabetes, chronic kidney disease, or vascular disease are most commonly at risk. It is recommended that patients with chronic kidney disease avoid dextran therapy.
