Hydroxyethylstarch or hetastarch is a synthetic colloid derived from amylopectin used as plasma substitute.
pentastarch (250 000 D) hetastarch (480 000 D)
0.058% to 0.085% (grade I to IV)
0.006% (grade III/IV)
Pruritus: 10 to 40%
General: anaphylactic shock.
Cutaneous: rash, urticaria, pruritus: beginning 1 to 3 weeks after HES infusion ; lasted 6 weeks to 6 months ; related to the type (concentration and molecular weight of HES ) and total infusion dose.
Intradermal skin-tests 0.05 ml Hetastarch 1/10 and pure: seldom positive.
Anti-HES IgM, IgG, IgA (ELISA) IgM are found 1/1004 in patients following administration of starch with no clinical significance.
One patient with high titers of IgG, IgM, IgA, 6 months after anaphylactic shock.
Non IgE-HES specific antibodies.
Pruritus: direct stimulation of cutaneous nerves by HES deposits in macrophages and endothelial cells.