Alternatives to Transfusion: A Case Report and Brief History of Artificial Oxygen Carriers

Sara Emily Bachert, MD; Prerna Dogra, MD; Leonard I. Boral, MD


Am J Clin Pathol. 2020;153(3):287-293. 

In This Article

Historical Perspective

The idea of a blood substitute or artificial oxygen carrier is not a new one. Modern efforts began at the beginning of the 20th century because an easily stored and transportable oxygen carrier would have been ideal during the world wars. Research in this field peaked in the 1990s to early 2000s as a result of the human immunodeficiency virus epidemic, not to mention problems with blood product contamination with other viruses (hepatitis B virus, hepatitis C virus) and bacteria.[1] With this historical context in mind, a manufactured blood substitute ideally should be readily available, capable of being stored at room temperature with a long half-life; eliminate (or at least significantly reduce) the ability to transmit infections; and lack antigenicity.[2,3] If such a product could be produced, it could play a major role not only in the care of Jehovah's Witnesses but also in patients undergoing surgery, trauma care patients, patients receiving multiple long-term blood transfusions (sickle cell disease, aplastic anemia, etc), and patients who are difficult to crossmatch (eg, those heavily alloimmunized because of warm autoimmune hemolytic anemia). With these goals in mind, there were two main approaches to engineering an artificial oxygen carrier: perfluorocarbons and hemoglobin-based oxygen carriers.[1] This review will briefly discuss the general properties of artificial oxygen carriers and describe a selection of the most notable products that have been developed in each category.