Clinical utility of human polymerized hemoglobin as a blood substitute after acute trauma and urgent surgery.
We have previously documented the safety of 1 unit (50 gram) of human polymerized hemoglobin (Poly SFH-P) in healthy volunteers. This report describes the first patient trial to assess the therapeutic benefit of Poly SFH-P in acute blood loss. Thirty-nine patients received 1 (n = 14), 2 (n = 2), 3 (n = 15), or 6 (n = 8) units of Poly SFH-P instead of red cells as part of their blood replacement after trauma and urgent surgery. There were no safety issues related to the infusion of Poly SFH-P. The plasma hemoglobin concentration ([Hb]) after the infusion of 6 units (300 gram) of Poly SFH-P was 4.8 +/- 0.8 g/dL (mean +/- SD). Although the red cell [Hb] fell to 2.9 +/- 1.2 g/dL, the total [Hb] was maintained at 7.5 +/- 1.2 g/dL. Poly SFH-P maintained total [Hb], despite the marked fall in red cell [Hb] due to blood loss. The utilization of O2 (extraction ratio) was 27 +/- 16% from the red cells and 37 +/- 13% from the Poly SFH-P. Twenty-three patients (59%) avoided allogeneic transfusions during the first 24 hours after blood loss. Poly SFH-P effectively loads and unloads O2 and maintains total hemoglobin in lieu of red cells after acute blood loss, thereby reducing allogeneic transfusions. Poly SFH-P seems to be a clinically useful blood substitute.
Gould
S A
SA
Department of Surgery, Michael Reese Hospital and University of Illinois, Chicago, USA.
Moore
E E
EE
Moore
F A
FA
Haenel
J B
JB
Burch
J M
JM
Sehgal
H
H
Sehgal
L
L
DeWoskin
R
R
Moss
G S
GS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D003404:Creatinine / Q000097:blood; D016903:Drug Monitoring; D005260:Female; D006339:Heart Rate; D006454:Hemoglobins / Q000032:analysis / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011732:Pyridoxal Phosphate / Q000031:analogs & derivatives* / Q000737:chemistry / Q000627:therapeutic use; D012151:Resuscitation / Q000379:methods; D013997:Time Factors; D014947:Wounds and Injuries / Q000601:surgery*
D006454:Hemoglobins; C030939:polyhemoglobin-pyridoxal-5-phosphate; D011732:Pyridoxal Phosphate; D003404:Creatinine