The life-sustaining capacity of human polymerized hemoglobin when red cells might be unavailable.

Abstract

BACKGROUND:

Human polymerized hemoglobin (PolyHeme, Northfield Laboratories, Evanston, IL) is a universally compatible, immediately available, disease-free, oxygen-carrying resuscitative fluid being developed as a red cell substitute for use in urgent blood loss. PolyHeme should be particularly useful when red cells may be temporarily unavailable. This article assesses survival at life-threatening RBC hemoglobin concentration ([Hb]) in massively bleeding patients who do not receive red cells.

STUDY DESIGN:

There were 171 patients who received rapid infusion of 1 to 20 units (1,000 g, 10 L) of PolyHeme in lieu of red cells as initial oxygen-carrying replacement in trauma and urgent surgery. The protocol simulated the unavailability of red cells, and the progressive fall in RBC [Hb] in bleeding patients was quantified. Thirty-day mortality was compared with a historical control group of 300 surgical patients who refused red cells on religious grounds.

RESULTS:

A total of 171 patients received rapid infusion of 1 to 2 units (n = 45), 3 to 4 units (n = 45), 5 to 9 units (n = 47), or 10 to 20 units (n = 34) of PolyHeme. Forty patients had a nadir RBC [Hb] < or = 3 g/dL (mean, 1.5 +/- 0.7 g/dL). But total [Hb] was adequately maintained (mean, 6.8 +/- 1.2 g/dL) because of plasma [Hb] added by PolyHeme. The 30-day mortality was 25.0% (10/40 patients) compared with 64.5% (20/31 patients) in historical control patients at these RBC [Hb] levels.

CONCLUSIONS:

PolyHeme increases survival at life-threatening RBC [Hb] by maintaining total [Hb] in the absence of red cell transfusion. PolyHeme should be useful in the early treatment of urgent blood loss and resolve the dilemma of unavailability of red cells.

• Authors: Steven A Gould, Ernest E Moore, David B Hoyt, Paul M Ness, Edward J Norris, Jeffrey L Carson, George A Hides, Ian H G Freeman, Richard DeWoskin, Gerald S Moss
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 195 Issue 4 Pg. 445-52; discussion 452-5 (Oct 2002) ISSN: 1072-7515 [Print] United States
• PMID: 12375748 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Substitutes
• Hemoglobins
• polyhemoglobin

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Blood Substitutes (therapeutic use)
• Erythrocyte Count
• Erythrocyte Transfusion
• Female
• Hemoglobins (analysis, therapeutic use)
• Hemorrhage (blood, mortality, therapy)
• Humans
• Male
• Middle Aged
• Survival Rate