Red Blood Cell Transfusion and the Quest for a Hemoglobin Substitute

Challenges and problems attendant to blood transfusion include uncertainty of the supply, donor procurement and screening for transmissible infection, blood processing and storage, overall costs and marginal insurance reimbursements, plus a host of possible complications in recipients of transfused blood products (most minor but some severe or life-threatening). Hence the quest for a safe and effective, off-the-shelf hemoglobin substitute. Efforts go back over half a century. Despite vast research, there is still no FDA-approved substitute. Substitutes have fallen into two classes: modified cell-free hemoglobins that function much like normal hemoglobin, and perfluorocarbons that passively dissolve oxygen. Thus far they have failed their promise although efforts to find a hemoglobin substitute continue. Success would constitute a landmark achievement.