Blood substitutes: evolution and future applications

Abstract

The development of oxygen-carrying blood substitutes has progressed significantly in the last decade with phase I and phase II clinical trials of both hemoglobin-based and perfluorocarbon-based oxygen carriers nearing completion. As these products approach clinical use it is important for the laboratory medicine community to be aware of their effects on routine laboratory testing and the settings in which they might be used. Here we review the forces driving the development of oxygen-carrying blood substitutes, the clinical settings in which they might be used, the major categories of oxygen carriers in clinical trials, and the challenges faced by these products as they approach clinical use.

Artificial Blood: A Futuristic Dimension of Modern Day Transfusion Sciences

“…Focused research and development in this field received an impetus in the mid 1980's following the apprehensions caused by the possibility of HIV infected blood [7][8][9]. Association of other infectious diseases like Hepatitis B, Hepatitis C, West Nile virus encephalitis, coronavirus, human T cell leukemia virus and bacterial infections with blood transfusions became increasingly recognized.…”

“…They release free radicals inside the body from free haemoglobin and the breakdown products like haem and iron. Methaemoglobin concentrations also increase due to the oxidative properties of HBOC's [7,8,24,25]. The first choice for obtaining haemoglobin is outdated human blood which has a limited supply.…”

“…Exposures to high oxygen concentration during PFC infusion can result in oxygen toxicity. PFC is also implicated in transient reduction in platelet counts which begins 3-4 days after administration and normalizes by 7 to 10 days [7]. Also, PFC products cannot be used by the human body and needs to be removed and this process requires around 18-24 months.…”

Acute normovolemic hemodilution in orthopedic surgery

“…Oxygencarrying solutions can effectively deliver oxygen to the tissues but their efficacy is transient because these drugs have short half-lives. 29 Perflubron is a perfluorochemical emulsion that is a temporary artificial oxygen carrier. A multinational, multicenter, randomized study evaluated the ability of perflubron to reverse physiologic transfusion triggers in 147 patients undergoing orthopedic surgery.…”

Immune recognition of exposed xenoantigens on the surface of PEGylated bovine red blood cells

“…Blood transfusion is a commonplace critical life saving procedure in modern medicine for the treatment of trauma victims and patients with a variety of diseases (Riess, 2001;Scott et al, 1997;Stollings and Oyen, 2006). However, with increasing blood demand and cost per unit of blood, decreasing donor supply, and risks associated with cross matching different blood types, transfusion research has focused on developing several types of universal oxygen therapeutics ranging from hemoglobin-based oxygen carriers (HBOCs), PEGylated red blood cells (RBCs) to perfluorocarbons (Moore, 2003;Patton and Palmer, 2005;Riess, 2001;Sakai et al, 2007;Stollings and Oyen, 2006;Winslow, 2003).…”