There are efforts to create a blood substitute have lasted over 70 years mainly targeting red blood cells oxygen transport.
Many advanced-phase clinical trial products are hemoglobin derivatives called oxygen carriers.
The rise in elective surgeries and the ongoing risk of blood-borne pathogens have prompted efforts to create a synthetic substitute for human red blood cells.
The oxyhemoglobin dissociation curve is sigmoid-shaped due to cooperative effects of hemoglobin’s oxygen binding sites.
Hemoglobin’s oxygen binding is influenced due to temperature and blood pH.
Stroma-free hemoglobin solutions offer advantages over red blood cells including sterilization resistance and a two-year room temperature shelf life.
Acellular hemoglobin solutions are less effective at oxygenation than packed red blood cells. Red blood cells release oxygen at a hemoglobin p-50 of about 26.5 mm Hg.
Blood transfusion risks stem from donor antigenicity and infection transmission. An ideal blood substitute should deliver oxygen comparably to normal human red blood cells
Indications
Trauma and emergency situations
Perioperative use
Patients with rare blood types
Chronic conditions
High-risk infections
A developed blood substitute would significantly enhance trauma care, elective surgeries, and support patients requiring long-term blood transfusions due to medical conditions.
Products may preserve organs and reduce reperfusion injury in donors.
Religious and ethnic groups concerned about human-derived blood products might accept them to enhance patient care.
Contraindications
Severe hemorrhagic shock
Inability to address coagulation deficits
Renal failure or kidney dysfunction
Hyperoxia
Uncontrolled Infection or Sepsis
Severe cardiovascular diseases
Outcomes
Equipment required:
Intravenous catheters
Infusion pumps and sets
Monitoring equipment
Supplemental oxygen equipment
Patient Preparation:
Review patient history for blood substitute contraindications.
Evaluate patient’s oxygenation pre-surgery to assess adequacy of blood substitutes for oxygen needs.
Choose blood substitute considering patient needs, procedure, and side effects.
Hemoglobin-Based Oxygen Carriers (HBOCs)
HBOCs require a sufficiently large IV catheter for fluid administration.
Dosage depends on patient’s weight, hemoglobin, and oxygen needs.
HBOCs are infused slowly to monitor for adverse reactions.
Continuously monitor patient’s vital signs during administration.
Monitor patient for delayed reactions up to 1-2 days after infusion.
Perfluorocarbon-Based Substitutes (PFCs):
PFCs are administered intravenously using a large-bore catheter for easy flow and to reduce clot.
PFCs need supplemental oxygen through nasal cannula/face mask during infusion to enhance oxygen-carrying capacity.
Oxygen saturation and respiratory status should be continuously monitored.
There are efforts to create a blood substitute have lasted over 70 years mainly targeting red blood cells oxygen transport.
Many advanced-phase clinical trial products are hemoglobin derivatives called oxygen carriers.
The rise in elective surgeries and the ongoing risk of blood-borne pathogens have prompted efforts to create a synthetic substitute for human red blood cells.
The oxyhemoglobin dissociation curve is sigmoid-shaped due to cooperative effects of hemoglobin’s oxygen binding sites.
Hemoglobin’s oxygen binding is influenced due to temperature and blood pH.
Stroma-free hemoglobin solutions offer advantages over red blood cells including sterilization resistance and a two-year room temperature shelf life.
Acellular hemoglobin solutions are less effective at oxygenation than packed red blood cells. Red blood cells release oxygen at a hemoglobin p-50 of about 26.5 mm Hg.
Blood transfusion risks stem from donor antigenicity and infection transmission. An ideal blood substitute should deliver oxygen comparably to normal human red blood cells
Trauma and emergency situations
Perioperative use
Patients with rare blood types
Chronic conditions
High-risk infections
A developed blood substitute would significantly enhance trauma care, elective surgeries, and support patients requiring long-term blood transfusions due to medical conditions.
Products may preserve organs and reduce reperfusion injury in donors.
Religious and ethnic groups concerned about human-derived blood products might accept them to enhance patient care.
Severe hemorrhagic shock
Inability to address coagulation deficits
Renal failure or kidney dysfunction
Hyperoxia
Uncontrolled Infection or Sepsis
Severe cardiovascular diseases
Intravenous catheters
Infusion pumps and sets
Monitoring equipment
Supplemental oxygen equipment
Patient Preparation:
Review patient history for blood substitute contraindications.
Evaluate patient’s oxygenation pre-surgery to assess adequacy of blood substitutes for oxygen needs.
Choose blood substitute considering patient needs, procedure, and side effects.
HBOCs require a sufficiently large IV catheter for fluid administration.
Dosage depends on patient’s weight, hemoglobin, and oxygen needs.
HBOCs are infused slowly to monitor for adverse reactions.
Continuously monitor patient’s vital signs during administration.
Monitor patient for delayed reactions up to 1-2 days after infusion.
Perfluorocarbon-Based Substitutes (PFCs):
PFCs are administered intravenously using a large-bore catheter for easy flow and to reduce clot.
PFCs need supplemental oxygen through nasal cannula/face mask during infusion to enhance oxygen-carrying capacity.
Oxygen saturation and respiratory status should be continuously monitored.
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