Polygeline
Also known as: degraded gelatin polypeptide, gelatin polypeptide colloid, Haemaccel, urea-crosslinked gelatin
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Summary
Polygeline is a synthetic, degraded gelatin polypeptide administered intravenously as a plasma volume expander. It is used in peri‑operative and critical‑care settings to restore intravascular volume after hemorrhage, surgery, or large‑volume paracentesis. Approval status is prescription‑only in several jurisdictions.
Mechanism of Action
Polygeline consists of cross‑linked gelatin fragments that remain in the vascular compartment, generating oncotic pressure that draws water into the bloodstream. The colloidal particles increase plasma colloid osmotic pressure, expanding circulating volume. The polymer can also activate mast cells, leading to histamine release that may provoke transient allergic‑type reactions.
What the Research Shows
Clinical reports compare polygeline with other colloids and crystalloids. A 1989 review highlighted its role in reducing interstitial fluid accumulation versus crystalloids. A 2010 randomized trial in hypovolaemic patients found that 500 mL of 3.5 % polygeline raised intrathoracic blood volume and blood pressure similarly to hydroxyethyl starch, without altering liver function as measured by ICG‑PDR. A 2003 volunteer study showed 100 % incidence of early and late histamine release after polygeline infusion, comparable to albumin and dextran. In coronary‑by‑pass surgery, intra‑operative fluid retention was lower with polygeline than with Ringer’s acetate, though postoperative fluid balance equalised. In cirrhotic patients undergoing large‑volume paracentesis, polygeline was less effective than albumin at preventing post‑paracentesis circulatory dysfunction, with higher rates of renin rise and poorer short‑term outcomes.
Reported Benefits
Polygeline reliably expands intravascular volume, improving haemodynamic parameters such as blood pressure and intrathoracic blood volume in acute hypovolaemia. Compared with crystalloids, it may limit interstitial fluid shift during surgery, and it is less costly than albumin. Its colloid nature provides a sustained oncotic effect for short‑term resuscitation.
Limitations of the Evidence
Evidence is limited to small, short‑term trials and specific clinical contexts. Polygeline does not outperform albumin in preventing circulatory dysfunction after large‑volume paracentesis. Histamine release is common, raising the risk of allergic reactions. Long‑term safety, mortality impact, and comparative effectiveness against newer synthetic colloids remain inadequately studied.
Safety Considerations
All volunteers in a histamine study exhibited early and late histamine release after polygeline, indicating a potential for urticaria, hypotension, or bronchospasm in susceptible individuals. No serious pulmonary complications were reported in surgical trials, but intra‑operative fluid retention was noted. Clinicians should monitor for allergic signs and consider patient history of hypersensitivity before infusion.
How It Is Administered
Polygeline is delivered intravenously, typically as a 3.5 % solution. Doses of 500 mL bolus have been used for rapid volume expansion in hypovolaemic patients and during surgery. It may also be given as a continuous infusion for ongoing resuscitation, depending on clinical judgment.
Routes of Administration
Goals & Uses
- Perioperative volume maintenanceAnesthesia / Perioperative CareModerate
- Hypovolemia treatmentHemodynamic StabilizationModerate
- Hemorrhagic shock resuscitationEmergency MedicineModerate
- Cardiopulmonary bypass primingCardiac SurgeryModerate
Contraindications
- Renal failure with oliguria/anuriaRenalModerate
- Simultaneous administration with blood through same lineDrug/fluid CompatibilityModerate
- Known hypersensitivity to gelatin or polygelineAllergyHigh
- Hypervolemia or congestive heart failureCardiovascularHigh
- Severe hypercalcemiaElectrolyte DisorderModerate
Adverse Effects
- Anaphylactoid/anaphylactic reactionImmunologicUncommon
- Fluid overload / pulmonary edemaCardiovascular/respiratoryUncommon
- Coagulation disturbancesHematologicUncommon
- Urticaria and pruritusDermatologicUncommon
- HypotensionCardiovascularUncommonLow blood pressure
- Electrolyte imbalanceMetabolicUncommonAbnormal blood electrolyte levels
Drug Interactions
- AminoglycosidesLow
- Cardiac glycosides (e.g., digoxin)Moderate
- Citrate-anticoagulated blood productsHigh
Population Constraints
- Pediatric patientsAgeRelative
- Patients with pre-existing coagulopathyHematologicRelative
- Patients with bovine gelatin allergy or known sensitizationAllergyAbsolute
- Pregnant womenReproductiveRelative
Regulatory Status
- European UnionApprovedApproved: Hypovolemia, Plasma volume expansionAvailable in several EU member states; regulatory status varies by country.
- United StatesUnapprovedNot FDA-approved; not commercially available in the United States.
- United KingdomApprovedApproved: Hypovolemia, Hemorrhagic shock, Plasma volume expansion, Cardiopulmonary bypass primingMarketed as Haemaccel; approved for use as a plasma substitute.
Approved and marketed in several countries (e.g., UK, India, parts of Europe and Asia) as Haemaccel. Not FDA-approved in the United States. Use has declined in some regions due to concerns about anaphylactoid reactions and questions about clinical outcomes compared to crystalloids.
Evidence & Sources
- Journal ArticleModerateDavies MJ1989-01-01T00:00:00.000000Z
- Journal ArticleModerateInal MT, et al.2010-01-01T00:00:00.000000Z
- Journal ArticleModerateCelik I, et al.2003-01-01T00:00:00.000000Z
- Journal ArticleModerateTølløfsrud S, et al.1995-01-01T00:00:00.000000Z
- Journal ArticleModerateZent O, et al.2003-01-01T00:00:00.000000Z
- Journal ArticleModerateGinès A, et al.1996-01-01T00:00:00.000000Z
Frequently Asked Questions
When is polygeline preferred over crystalloids?
Polygeline is considered when rapid intravascular volume expansion is needed and clinicians wish to limit interstitial fluid accumulation, such as during major surgery or acute hemorrhage, provided the patient has no known hypersensitivity.
How does polygeline compare with albumin for fluid replacement?
In cirrhotic patients undergoing large‑volume paracentesis, albumin was more effective than polygeline at preventing post‑paracentesis circulatory dysfunction. In other settings, polygeline and albumin produce similar short‑term haemodynamic improvements, but albumin is more costly.
What are the main adverse reactions to watch for?
The most consistent finding is histamine release, which can cause flushing, itching, hypotension, or bronchospasm. Monitoring for allergic symptoms during and after infusion is recommended, especially in patients with a history of mast‑cell disorders.
Is polygeline used in vaccine formulations?
No. A tick‑borne encephalitis vaccine evaluated in 2003 was specifically described as polygeline‑free, indicating that polygeline is not a component of that vaccine.
Can polygeline be used for patients with liver disease?
A trial in hypovolaemic patients showed no significant impact on liver function tests after a single 500 mL infusion. However, its effectiveness in liver disease is less clear, and albumin remains the preferred plasma expander for preventing circulatory dysfunction in cirrhosis.
What is Polygeline?
Polygeline is a synthetic, degraded gelatin polypeptide administered intravenously as a plasma volume expander. It is used in peri‑operative and critical‑care settings to restore intravascular volume after hemorrhage, surgery, or large‑volume paracentesis. Approval status is prescription‑only in several jurisdictions.
What is Polygeline used for?
Polygeline is educationally associated with: Perioperative volume maintenance, Hypovolemia treatment, Hemorrhagic shock resuscitation, Cardiopulmonary bypass priming. Educational only — not medical advice.
How is Polygeline administered?
Recorded routes of administration: Intravenous.
What are the potential side effects of Polygeline?
Reported adverse effects include: Anaphylactoid/anaphylactic reaction, Fluid overload / pulmonary edema, Coagulation disturbances, Urticaria and pruritus, Hypotension, Electrolyte imbalance. This list is not exhaustive — consult a qualified clinician.
Who should avoid Polygeline?
Recorded contraindications: Renal failure with oliguria/anuria, Simultaneous administration with blood through same line, Known hypersensitivity to gelatin or polygeline, Hypervolemia or congestive heart failure, Severe hypercalcemia. Consult a qualified clinician before use.