Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
Continuing Medical Education
2001:67:5;228-230
PMID: 17664756

Low molecular weight dextran

S Smitha Prabhu
 Department of Dermatology and Venereology, Medical College Hospital, Calicut - 673 008, India

Correspondence Address:
S Smitha Prabhu
Department of Dermatology and Venereology, Medical College Hospital, Calicut - 673 008
India
How to cite this article:
Prabhu S S. Low molecular weight dextran. Indian J Dermatol Venereol Leprol 2001;67:228-230
Copyright: (C)2001 Indian Journal of Dermatology, Venereology, and Leprology

Syn: Lomodex, Rheomacrodex, Gentran 40, Rheotran[1]

Dextran (C6H1005)n is a gum produced from cane or beet sugar where it is formed by the action of a contaminating bacterium Leuconostoc mesenteroides. Native dextran is a polymer of glucose with a molecular weight around 40 million; from which is prepared relatively lower molecular weight dextrans: high molecular weight (HMW) dextran of molecular weight 70000 and Low molecular weight (LMW) dextran, which is a mixture of dextrose polymers with an average molecular weight of 40000 (i.e., 10000-70000), in which the glucosidic linkage is of the a (1?6) type.[1]

Mechanism of production:

Sucrose is acted upon by the bacterium Leuconostoc mesenteroides B512 and is converted to crude high molecular weight dextran which is then hydrolyzed and fractionated to obtain a molecular weight of 40000, or alternatively, low molecular weight dextran is obtained by degrading dextran with acid and purifying the correct sized dextran from the resulting mixture.[2]

Properties

It is an amorphous, odorless and tasteless powder. 10% solution of dextran 40 in 5% dextrose in water darkens slightly over long storage period. Darkening is aggravated by increased ambient temperature. Low molecular weight dextran is excreted by the kidneys. The half-life of dextran is about 24 hours. Renal insufficiency increases the half-life of LMW dextran by a factor of 6.[3]

Mechanism of action and effects on systems

1. It lowers viscosity of blood and improves flow. In part, the improvement in flow is the result of hemodilution.

2. Platelet adhesion is decreased.

3. It decreases serum fibrinogen and clotting factors.

4. Decreases rouleux formation by RBCs and has an antisludging effect on blood.

5. Dextran 40 inhibits adhesion of T- lymphocytes to endothelial cells?

6. Low molecular weight dextran firmly adheres to circulating RBCs in vivo. It also attaches itself to arterial walls, which have been damaged by physical rather than chemical bonding. This molecular coating may sterically prevent the critical concentration of substances necessary for clotting or may insulate or counter transmural thrombogenic potentials. This is the mechanism proposed of its action in Raynaud′s phenomenon and other arterial diseases.[8]

Uses

Dermatological conditions:

1. Deep vein thrombosis and thrombophlebitis

2. Raynaud′s phenomenon[4]

3. Anti phospholipid syndrome - impending digital gangrene

4. Frost bite.[3]

5. Cutaneous cholesterol emboli

6. Livedo reticularis with ulceration[9]

Other Uses

1. Isotonic solution is used to prime pumps or improve flow in surgery requiring cardiopulmonary bypass.

2. As prophylactic for thrombosis and thromboembolism during and after surgery.

3. To decrease coagulopathies during shock - used only for a short period of time. (Otherwise dextran 40 is seldom used in shock because of short duration in the body and frequent adverse effects)

4. Stroke

5. Improvement of circulation in transplant and graft procedures.

6. As a plasma expander.

Method of administration

As a 10% intravenous solution in 5% dextrose or in Normal saline. First inject 20 ml IV over 3 to 5 minutes to decrease the risk of anaphylaxis. Then infuse 20-30 ml per hour up to a maximum of 2 to 3 litres per day.

In Raynaud′s phenomenon: infuse 500--1000 ml over 4 - 6 hours on day 1. 500 ml on day 2. then on alternate days for 10 days.[5]

Side effects

1. Acute renal failure: There is accumulation of low molecular weight fraction in the renal tubules, which induces vacuolization of proximal tubular cells. It may also cause edema and disrupt integrity of the capillary membrane. All these effects are maximized especially when there is pre-existing renal impairment.

2. Bleeding tendency: It decreases viscosity of blood and platelet adhesion, therefore causing increased bleeding, especially in people with pre-existing coagulopathies, and in those who are on concomitant anti-platelet drugs.

3. Anaphylaxis: by histamine release. Occurs in 1-5% of cases. Manifests as urticaria, wheezing, and tightness of chest.[6]

4. Nausea and vomiting

5. Hypotension

6. Bleeding tendency - especially if on concomitant anti platelet drugs.

Contra - indications for use

1. Congestive cardiac failure

2. Severe coagulative disorders

3. Hypervoluemic conditions

4. Hypersensitivity to dextran

5. Severe dehydration

Precautions

1. Dextran 40 interferes with cross matching of blood, especially when enzyme methods are used.

2. It interferes with some tests of renal and hepatic function and with assays for blood sugar in which acid hydrolytic method is used.

3. Adequate hydration is to be ensured before starting the patient on low molecular weight dextran.

4. Low specific gravity of urine indicates impaired renal excretion of LMW dextran, and it should be discontinued.

5. Monitoring of serum osmolarity is necessary. If serum osmolarity is> 300 m Osm/I, LMW dextran should be discontinued.

6. Dose should never exceed more than 10% of the blood volume.

7. Precautions to guard against renal failure.[2]

  • Do not infuse more than 20 ml/ kg per day.
  • Do not give if the urine output is less than 1500 ml per day or if the blood urea is 60 mg/ml or higher.
  • Do not give any more if the urine output drops or the specific gravity of the urine rises above 1045 during administration. In such cases try to maintain a high urine output by using diuretics and a high fluid intake.

Preparations available

Inj 10% in 5% dextrose solution, 500 ml.

Inj 10% in 0.9% sodium chloride solution, 500 ml.

Dextran can be stored for up to 10 years and is relatively cheap.

Future uses

1. In cystic fibrosis - to decrease the viscid mucus.

2. It may be useful for therapeutic intervention in diseases associated with enhanced T-lymphocyte binding to microvascular endothelium.

References
1.
Misher A. Low molecular weight blood, fluids. Electrolytes and haematologic drugs. In : Gennaro AR, Chase Go, Melvin RG, et al Editors. Remington's Pharmaceutical Sciences. Pennsylvaina : Mack Publishing Company; 1985.
[Google Scholar]
2.
Satoskar RS, Bhandarkar SD. Pharmacotherapy of shock. In Satoskar RS, Bhandarkar SD, Editors. Pharmacology and Pharmacotherapeutics. Bombay; Popular Prakashan : 1993.
[Google Scholar]
3.
Belch JJ, Ho M. Pharmacotherapy of Raynaud's phenomenon. Drugs 1996;52:682 - 695.
[Google Scholar]
4.
Dowd PM. Diseases of abnormal sensitivity to cold. In: Champion RH, Burton JL, Burns DA, et al. Eds. Textbook of Dermatology. Hong Kong; Blackwell Science: 1998.
[Google Scholar]
5.
Wong HW. Low molecular weight dextran therapy for scleroderma. Arch Dermatol 1974; 110 : 419 - 422.
[Google Scholar]
6.
Kemp SF, Lockey RF, Wolf BL, et al. Anaphylaxis. A review of 266 cases. Arch Intern Med 1995; 155 : 1749 - 1754.
[Google Scholar]
7.
Termeer CC, Weiss IM, Schopf W, et al. The low molecular weight Dextran 40 inhibits the adhesion of T- lymphocytes to endothelial cells. Clin Exp Immunol 1998;114: 422 - 426.
[Google Scholar]
8.
Holti G. The effect of intermittent low molecular weight dextran infusion upon the digital circulation in systemic sclerosis. Br 3 Dermatol 1965; 77 : 560-568.
[Google Scholar]
9.
Issroff SW, Whiting DA. Low molecular weight dextran in the treatment of livedo reticularis with ulceration. Br J Dermatol 1971; 85 (Suppl 7) : 216 - 231.
[Google Scholar]
Show Sections