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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 379-388, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
GJ Vlahakes, R Lee, EE Jacobs Jr, PJ LaRaia and WG Austen
Recent concerns regarding the safety of the national blood supply have
rekindled interest in the development of blood substitutes. Clinical
studies have dampened the initial enthusiasm for fluorocarbon solutions as
blood substitutes. The potential of hemoglobin solutions as blood
substitutes has continued to stimulate investigations. However, the
development of an ideal hemoglobin-derived blood substitute has eluded
investigators for the past century. A persistent problem has been the
inability to develop hemoglobin solutions that provide adequate oxygen and
carbon dioxide exchange, while avoiding toxicity that precludes clinical
safety and long-term survival. Traditionally, investigators have focused on
human hemoglobin solutions. The use of outdated banked blood or pedigree
human donor blood as a hemoglobin source poses continued disease
transmission risks and a prohibitively limited supply. We evaluated the
hemodynamic and gas transport effects of a new purified, polymerized bovine
hemoglobin preparation. Bovine hemoglobin oxygen affinity is regulated by
chloride ion. The concentration of chloride ions in human plasma results in
excellent oxygen transport properties in a stroma-free environment. In
addition, unlike human blood, bovine blood is a more disease-free
hemoglobin source that is available in large supply. We exchange-transfused
eight conscious sheep with this new polymerized bovine hemoglobin solution.
All animals tolerated greater than or equal to 95% exchange transfusion to
reach a final ovine hematocrit of 2.4 +/- 0.5% with stable hemodynamics and
no clinical evidence of distress. The exchange transfusion with bovine
hemoglobin polymer resulted in a final plasma hemoglobin concentration of
6.1 +/- 1.6 gm/dl, which supported oxygen consumption at baseline levels.
All animals that were exchange transfused with this preparation survived
long term with rapid resynthesis of ovine erythrocytes.
ARTICLES
Hemodynamic effects and oxygen transport properties of a new blood substitute in a model of massive blood replacement
Department of Surgery, Massachusetts General Hospital, Boston 02114.
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