Journal-Feb2008

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Transfusion
The Journal of AABB
February 2008 - Vol. 48 Issue 2 Page 203-404

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( A *.rar file include pdf files)

Hb

Hemoglobin is a protein that is carried by red cells. It picks up oxygen in the lungs and delivers it to the peripheral tissues to maintain the viability of cells. Hemoglobin is made from two similar proteins that "stick together". Both proteins must be present for the hemoglobin to pick up and release oxygen normally. One of the component proteins is called alpha, the other is beta. Before birth, the beta protein is not expressed. A hemoglobin protein found only during fetal development, called gamma, substitutes up until birth.

Artifical Blood & World

Here are the name of 4 famous companies which are working on this issue in the world:

-Biopure Corporation, Cambridge, USA

Product : HemopureTM.

Source : Polymerised bovine Hb,Africa 2001.

Clinical trial level:Approved for use in South .
Application : Clinical use to treat acute anaemia and as alternative to donated blood in transfusion.

-Hemosol Incorporated, Toronto, Canada
Product :HemolinkTM.
Source : Phase III trials completed.
Clinical trial : Phase III trials completed.
Application : Application for use during cardiac surgery filed to regulatory authorities.

-Sangart Incorporated, San Diego, USA
Product : HemospanTM.
Source : Conjugated human Hb.
Clinical trial level: Phase Ib/II initiated in Sweden 2003.
Application : Trials underway in orthopaedic surgery.


-Baxter International,Deerfield, USA
Product : OptroTM.
Source : Cross-linked Hb from genetically modified E. coli bacteria.
Clinical trial level: Phase II trials completed.
Application : Trials completed in patients undergoing surgery in 1999.

First use

The first successful use of the artificial cell in routine clinical applications is hemoperfusion . After initial clinical trials for poisoning, kidney failure, and liver failure , it is now in routine clinical use, especially for the treatment of suicidal or accidental poisoning from medications . It is also being used in combination with the hybrid artificial liver in clinical trials.

Blood Substitute

The term 'blood substitute' is a little misleading since their development so far has concentrated primarily on only the blood's function to carry oxygen to our tissues. A more accurate term for blood substitutes being developed would be either:
Cell-free oxygen carriers
Oxygen therapeutics
Red cell substitutes
Essentially, blood substitutes are fluids which, when injected into the human blood stream, contribute significantly to the transport of oxygen around the body. What constitutes a suitable substitute?
Scientists have identified that an ideal blood substitute should have several key properties. These would ensure that a substitute would be free of all of the problems associated with donated human blood when it is used in transfusion. Such properties include:
Adequate oxygen uptake in the lungs
Adequate oxygen delivery to the tissues
Long circulation time
Non-toxic
Rapidly excreted without causing harm
Stable at room temperature and readily available for use
Easily sterelisable (i.e. easy to ensure absence of pathogens such as viruses)
Cheap to manufacture
Long shelf life and easy to store
Widely applicable (i.e. no need for crossmatching or compatibility testing)
Free of any side effects
There are 3 key advantages to a blood substitute that meets all of these criteria, and it is these that make the prospect of developing an effective substitute very exciting:
Unlike red blood cells, a blood substitute could be sterilised, this would mean the problems of disease spreading would be removed from transfusions.
Problems of human error, (mismatching of blood types) with donated blood would be removed since a substitute would not contain the properties of blood that cause this.
A blood substitute could be stored stably for a long time, which would allow for transport to third world countries or to a battlefield, or site of natural disaster without the need for refrigerators. Effectively there would be trouble free availability of blood.

Blood substitutes

Blood substitutes, often called artificial blood, are used to fill fluid volume and/or carry oxygen and other blood gases in the cardiovascular system. Although commonly used, the term is not accurate since human blood performs many important functions. Red blood cells transport oxygen, white blood cells defend against disease, platelets promote clotting, and plasma proteins provide various functions. The preferred and more accurate terms are volume expanders for inert products, and oxygen therapeutics for oxygen-carrying products. Examples of these two "blood substitute" categories: Volume expanders: inert and merely increase blood volume. These may be crystalloid-based (Ringer's lactate, normal saline, D5W (dextrose 5% in water) or colloid-based (Haemaccel, Gelofusin). Oxygen therapeutics: mimic human blood's oxygen transport ability. Examples: Hemopure, Oxygent, PolyHeme. Oxygen therapeutics are in turn broken into two categories based on transport mechanism: perfluorocarbon based, and hemoglobin based. Volume expanders are widely available and are used in both hospitals and first response situations by paramedics and emergency medical technicians. Oxygen therapeutics are in clinical trials in the U.S. and Europe, however Hemopure is more widely available in South Africa.

Introduction

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