Date of Award

Spring 2020

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Shannon Diallo, PA-C

Abstract

Abstract

Introduction: Allogenic red blood cell (RBC) transfusions are used for a number of different reasons. As with any medical procedure, allogenic RBC transfusions are not risk-free. Since the first recorded blood transfusion in 1655, the process has remained relatively unchanged. ABO incompatibility and contamination with infectious diseases are two major complications associated with RBC transfusions. Furthermore, traditional allogenic RBC transfusions have supply and demand issues. These issues, plus several more, could be alleviated with the use of artificial blood. This paper addresses the important clinical question: In patients who require RBC transfusions (P), is there a viable artificial blood product (I) that would reduce the need for allogenic RBC transfusions (O) when compared to traditional allogenic RBC transfusions (C)?

Methods: A literature search was completed through PubMed and Google Scholar in November 2018. Several articles were chosen based on relevance to the question, as well as specific inclusion and exclusion criteria. In January 2019 a second literature search was completed through PubMed and Google Scholar, this time using slightly different inclusion criteria. A total of three articles were chosen from this search. Seven total articles were chosen for this paper.

Results: Based on the literature review, there is hopeful evidence that an artificial blood product might be viable for future use. Several studies found that patients infused with an RBC substitute required fewer infusions than those receiving traditional allogenic RBC transfusions. Two studies suggested artificial blood products were either just as effective or more effective when compared to allogenic RBC transfusions in emergency situations, such as hemorrhagic shock. On the other hand, several studies showed statistically significant differences in clinical chemistry and/or hematologic values for patients infused with RBC substitutes when compared to those transfused with allogenic RBCs.

Discussion: Most of the studies suggested artificial blood products are an acceptable replacement for allogenic RBC transfusions. However, there was a high degree of variability between the studies. Two studies investigated the use of artificial blood products in situations of hemorrhagic shock. Four studies investigated the use of artificial blood products in surgical settings. Finally, one study investigated the effects of an artificial blood product on healthy individuals. Infusion criteria varied between the studies, and several studies did not have well defined infusion criteria. Outcome measurements varied between studies, and included (but were not limited to) hemoglobin, hematocrit, ALT, AST, body temperature, electrocardiograms, and mean arterial pressure. Despite the variability between the studies, favorable outcomes were appreciated with the use of artificial blood products in nearly all the studies.

Conclusion: There are currently no artificial blood products approved for use in the United States. However, several products have shown promising results in clinical trials. As such, the lack of artificial blood products is not due to a lack of efficacy of such products. Artificial blood products could reduce the risk of ABO incompatibility, contraction of infectious diseases, and shortages of blood supplies. Further research will be crucial to the future of artificial blood products in the field of transfusion medicine.

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ALTERNATIVES TO RED BLOOD CELL TRANSFUSIONS

Abstract

Introduction: Allogenic red blood cell (RBC) transfusions are used for a number of different reasons. As with any medical procedure, allogenic RBC transfusions are not risk-free. Since the first recorded blood transfusion in 1655, the process has remained relatively unchanged. ABO incompatibility and contamination with infectious diseases are two major complications associated with RBC transfusions. Furthermore, traditional allogenic RBC transfusions have supply and demand issues. These issues, plus several more, could be alleviated with the use of artificial blood. This paper addresses the important clinical question: In patients who require RBC transfusions (P), is there a viable artificial blood product (I) that would reduce the need for allogenic RBC transfusions (O) when compared to traditional allogenic RBC transfusions (C)?

Methods: A literature search was completed through PubMed and Google Scholar in November 2018. Several articles were chosen based on relevance to the question, as well as specific inclusion and exclusion criteria. In January 2019 a second literature search was completed through PubMed and Google Scholar, this time using slightly different inclusion criteria. A total of three articles were chosen from this search. Seven total articles were chosen for this paper.

Results: Based on the literature review, there is hopeful evidence that an artificial blood product might be viable for future use. Several studies found that patients infused with an RBC substitute required fewer infusions than those receiving traditional allogenic RBC transfusions. Two studies suggested artificial blood products were either just as effective or more effective when compared to allogenic RBC transfusions in emergency situations, such as hemorrhagic shock. On the other hand, several studies showed statistically significant differences in clinical chemistry and/or hematologic values for patients infused with RBC substitutes when compared to those transfused with allogenic RBCs.

Discussion: Most of the studies suggested artificial blood products are an acceptable replacement for allogenic RBC transfusions. However, there was a high degree of variability between the studies. Two studies investigated the use of artificial blood products in situations of hemorrhagic shock. Four studies investigated the use of artificial blood products in surgical settings. Finally, one study investigated the effects of an artificial blood product on healthy individuals. Infusion criteria varied between the studies, and several studies did not have well defined infusion criteria. Outcome measurements varied between studies, and included (but were not limited to) hemoglobin, hematocrit, ALT, AST, body temperature, electrocardiograms, and mean arterial pressure. Despite the variability between the studies, favorable outcomes were appreciated with the use of artificial blood products in nearly all the studies.

Conclusion: There are currently no artificial blood products approved for use in the United States. However, several products have shown promising results in clinical trials. As such, the lack of artificial blood products is not due to a lack of efficacy of such products. Artificial blood products could reduce the risk of ABO incompatibility, contraction of infectious diseases, and shortages of blood supplies. Further research will be crucial to the future of artificial blood products in the field of transfusion medicine.