Artificial blood substitutes are designed to replace the oxygen-carrying capacity of lost red blood cells in the case of major bleeding (on the battlefield, major intraoperative blood loss). The declared aim is reduction of homologous blood transfusion with its associated costs and risks (virus transmission, immunosuppression, and hemolytic reaction).

To date, approximately 12 million units of red blood cells are transfused each year in the United States, half of them to patients aged 65 years or more. As the number in this age group increases and blood donation decreases, a shortfall of about 4 million units of red blood cells is projected for the year 2030 and an explosion in costs has to be taken into account (actual cost $52 to $64 per unit, expected cost above $200 per unit) ( Dietz ef al; 1996).

The risks of transmission of HIV and non-A non-B hepatitis are currently estimated as 1 in 225 000 transfusions and 1 in 3000 transfusions respectively. Although rare, once virus transmission and outbreak of the disease have occurred, the costs of treatment are enormous (A.uB..u.cho.n aDd,...B,ilk.m®y§L1994).

Major homologous blood transfusion acts as an immunodepressant and increases the incidence of infections, even sepsis syndrome, in the postoperative period. Prolonged stay in hospital and, in the worst case, the necessity for treatment in an intensive care unit represent an important cost factor for the health care system.

Therefore a safe and effective blood substitute could help to prevent a shortfall in the red blood cell supply as well as the increment in costs due to homologous blood transfusion. Several types of products are under preclinical and clinical investigation: solutions of free hemoglobin, liposome-encapsulated hemoglobin, and perfluorocarbons.

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