Foamy Macrophage Syndrome due to Hydroxyethyl Starch Replacement: A Severe Side Effect in Plasmapheresis
Authors: Johannes J.A. Auwerda
Journal: Annals of Internal Medicine (2002)

Letters17 December 2002Foamy Macrophage Syndrome due to Hydroxyethyl Starch Replacement: A Severe Side Effect in PlasmapheresisJohannes J.A. Auwerda, MD, J.H. Paul Wilson, MD, and Pieter Sonneveld, MD, PhDJohannes J.A. Auwerda, MDErasmus Medical Center; 3008 AE Rotterdam, the Netherlands, J.H. Paul Wilson, MDErasmus Medical Center; 3008 AE Rotterdam, the Netherlands, and Pieter Sonneveld, MD, PhDErasmus Medical Center; 3008 AE Rotterdam, the NetherlandsAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-12-200212170-00037 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:A 38-year-old woman had received stanozolol, cyclosporine, and frequent plasmapheresis since 1997 because of IgG λ monoclonal gammopathy with cryoglobulinemia-associated ulcerating leukocytoclastic vasculitis. Initially, gelatin-based plasma expanders and pasteurized human albumin were used. Beginning in February 1999, plasma volumes were exchanged at a 1:1 ratio with undiluted 6% hydroxyethyl starch (HES) (Fresenius–Kabi, Hamburg, Germany) because of the reported advantages of HES.In August 2000, the patient developed severe weight loss, sensory polyneuropathy of the legs, and deteriorating eyesight. On examination, she was malnourished (body mass index, 17.6 kg/m2) with hepatosplenomegaly and ascites. She had normocytic anemia (hemoglobin ...References1. Yacobi A, Stoll RG, Sum CY, Lai CM, Gupta SD, Hulse JD. Pharmacokinetics of hydroxyethyl starch in normal subjects. J Clin Pharmacol. 1982;22:206-12. [PMID: 6178760] CrossrefMedlineGoogle Scholar2. Jurecka W, Szépfalusi Z, Parth E, Schimetta W, Gebhart W, Scheiner O, et al . Hydroxyethylstarch deposits in human skin—a model for pruritus? Arch Dermatol Res. 1993;285:13-9. [PMID: 7682398] CrossrefMedlineGoogle Scholar3. Sirtl C, Laubenthal H, Zumtobel V, Kraft D, Jurecka W. Tissue deposits of hydroxyethyl starch (HES): dose-dependent and time-related. Br J Anaesth. 1999;82:510-5. [PMID: 10472213] CrossrefMedlineGoogle Scholar4. Ständer S, Szépfalusi Z, Bohle B, Ständer H, Kraft D, Luger TA, et al . Differential storage of hydroxyethyl starch (HES) in the skin: an immunoelectron-microscopical long-term study. Cell Tissue Res. 2001;304:261-9. [PMID: 11396719] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Johannes J.A. Auwerda, MD; J.H. Paul Wilson, MD; Pieter Sonneveld, MD, PhDAffiliations: Erasmus Medical Center; 3008 AE Rotterdam, the Netherlands PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byA pilot study on impact of use of medium molecular weight hydroxyethyl starch in granulocyte apheresis using Spectra OptiaGranulocyte collection by polymorphonuclear cell-targeting apheresis with medium-molecular-weight hydroxyethyl starchCutaneous lymphohistiocytic infiltrates with foamy macrophages: A novel histopathological clue to Stenotrophomonas maltophilia septicemiaThe Dilemma for Using Hydroxyethyl Starch Solutions for Perioperative Fluid ManagementHydroxyethyl starches in equine medicineImpact of hydroxyethyl starch and modified fluid gelatin on granulocyte phenotype and functionVolumenersatzlösungenGranulocytapheresis with modified fluid gelatin versus high‐molecular‐weight hydroxyethyl starch: a matched‐pair analysisUse of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicityHow safe is gelatin? 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