Transfusion Alternatives in Trauma

Abstract

SUMMARY Restoration of oxygen‐carrying capacity plays an essential role in the management of trauma patients. The potential risks associated with allogeneic blood, as well as the immunosuppressive potential of transfusions, have stimulated interest in alternatives to allogeneic blood transfusion. In the setting of trauma, the feasible alternatives are limited to autotransfusion and blood substitutes. Autotransfusion avoids infectious risks and obviates compatibility testing. However, coagulopathy remains a significant problem associated with autotransfusion. Hemoglobin substitutes offer many theoretical advantages over allogeneic transfusion. Several formulations have been investigated in clinical trials. Our experience has been exclusively with a polymerized, pyridoxylated stroma‐free human hemoglobin‐based solution (PolyHeme). In infusions up to 10 units (5 liters) PolyHeme has proved an adequate oxygen carrier without serious adverse effects, and has reduced the need for allogeneic blood. Given its safety, efficacy, and favorable immunomodulatory profile, PolyHeme appears to have tremendous potential as an alternative to transfusion.