Orthopaedic patients frequently require blood transfusions to treat peri-operative anemia. Research in the area of hemoglobin substitutes has been of great interest since it holds the promise of reducing the reliance on allogeneic blood transfusions. The three categories of hemoglobin substitutes are (1) cell-free, extracellular hemoglobin preparations made from human or bovine hemoglobin (hemoglobin-based oxygen carriers or HBOCs); (2) fluorinesubstituted linear or cyclic carbon chains with a high oxygen-carrying capacity (perfluorocarbons); and (3) liposome-encapsulated hemoglobin. Of the three, HBOCs have been the most extensively studied and tested in preclinical and clinical trials that have shown success in diminishing the number of blood transfusions as well as an overall favorable side-effect profile. This has been demonstrated in vascular, cardiothoracic, and orthopaedic patients. HBOC- 201, which is a preparation of cellfree bovine hemoglobin, has been approved for clinical use in South Africa. These products may well become an important tool for physicians treating peri-operative anemia in orthopaedic patients.
KeywordsHemoglobin substitute HBOC HBOC-201 Perfluorocarbons
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- 7.Greer JP, Foerster J, Lukens JN (eds) (2003) Transfusion medicine. In: Wintrobe’s clinical hematology. Lippincott, PhiladelphiaGoogle Scholar
- 8.Guyton AC (2000) Red blood cells, anemia, and polycythemia. In: Textbook of medical physiology, 10th edn. WB Saunders, PhiladelphiaGoogle Scholar
- 10.Jahr JS, Stewart LM, MacKenzie C, Bourke DL, Williams JP (2002) Pivotal phase III study: safety of polymerized bovine hemoglobin (HBOC-201, Hemopure) as compared to RBC in patients undergoing orthopaedic surgery. Anesthesiology Supplement] 97:A243Google Scholar
- 16.Levy JH, Goodnough LT, Greilich PE, Parr GVS, Stewart RW, Gratz I, Wahr J, Williams J, Comunale ME, Doblar D, Silvay G, Cohen M, Jahr JS, Vlahakes GJ (2002) Polymerized bovine hemoglobin solution as a replacement for allogeneic red blood cell transfusion after cardiac surgery: results of a randomized, double-blind trial. J Thorac Cardiovasc Surg 124:35–42CrossRefPubMedGoogle Scholar
- 18.Menitove JE (2000) Transfusion-transmitted diseases. In: Hoffman R (ed) ematology: basic principles and practice, 3rd edn. Churchill Livingstone, New YorkGoogle Scholar
- 21.Spahn DR, Waschke KF, Standl T, Motsch J, Van Huynegem L, Welte M, Gombotz H, Coriat P, Verkh L, Faithfull S, Keipert P (2002) Use of Perflubron emulsion to decrease allogeneic blood transfusion in high-bloodloss non-cardiac surgery: results of a European phase 3 study. Anesthesiology 97:1338–1349PubMedGoogle Scholar
- 23.Standl T, Horn P, Wilhelm S, Greim C, Freitag M, Freitag U, Sputtek A, Jacobs E, Schulte am Esch J (1996) Bovine hemoglobin is more potent than autologous red blood cells in restoring muscular tissue oxygenation after profound isovolaemic haemodilution in dogs. Can J Anaesth 43:714–723PubMedGoogle Scholar
- 27.Winslow RM (2000) Red cell substitutes. In: Hoffman R (ed) Hematology: basic principles and practice, 3rd edn. Churchill Livingstone, New YorkGoogle Scholar
- 28.York GB, Eggers JS, Smith DL, Jenkins DH, McNeil JD, Mueller D, Josephs JD, Kerby JD (2003) Low-volume resuscitation with a polymerized bovine hemoglobin-based oxygen-carrying solution (HBOC-201) provides adequate tissue oxygenation for survival in a porcine model of controlled hemorrhage. J Trauma 55:873–885PubMedGoogle Scholar