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Supra-plasma expanders: the future of treating blood loss and anemia without red cell transfusions?
Amy G Tsai1, Beatriz Y Salazar Vázquez, Axel Hofmann
1University of California, San Diego, Department of Bioengineering, La Jolla, California (Drs Tsai, Salazar Vázquez, and Intaglietta); Universidad Nacional Autónoma de México, Hospital General de México "Dr. Eduardo Liceaga," Department of Experimental Medicine, México DF, México (Dr Salazar Vázquez); Universidad Juárez del Estado de Durango, Victoria de Durango, Faculty of Medicine, Dgo, Mexico (Dr Salazar Vázquez); University Hospital, Institute of Anesthesiology, Zürich, Switzerland (Dr Hofmann); University of Western Australia, School of Surgery, Perth, Australia (Dr Hofmann); and Albert Einstein College of Medicine, Department of Hematology and Medicine, Bronx, New York (Dr Acharya). Amy G. Tsai, PhD, is a research scientist and principal investigator in the Department of Bioengineering of the University of California, San Diego. She specializes in the study of in vivo microvascular responses to hemorrhagic shock and acute anemia, with the aim of developing new resuscitation fluids, next-generation plasma expanders, and oxygen carriers. Beatriz Y. Salazar Vázquez, MD, PhD, is a visiting scholar at the University of California, San Diego, and a research scientist at the Universidad Nacional Autónoma de México, where she studies the cardiovascular effects of hematocrit changes. Axel Hofmann, ME, is a visiting professor at the Institute of Anesthesiology at University Hospital in Zürich, Switzerland, and an adjunct associate professor in the School of Surgery at the University of Western Australia. Seetharama A. Acharya, PhD, is a professor of hematology and biophysics at the Albert Einstein College of Medicine in New York. He is an expert on protein peglylation design as applied to its use as blood replacement fluids. Marcos Intaglietta, PhD, is a distinguished professor of bioengineering at the University of California, San Diego, and is an authority in the analysis of the microcirculation and how it behaves during changes of blood composition resul
Oxygen delivery capacity during profoundly anemic conditions depends on blood's oxygen-carrying capacity and cardiac output. Oxygen-carrying blood substitutes and blood transfusion augment oxygen-carrying capacity, but both have given rise to safety concerns, and their efficacy remains unresolved. Anemia decreases oxygen-carrying capacity and blood viscosity. Present studies show that correcting the decrease of blood viscosity by increasing plasma viscosity with newly developed plasma expanders significantly improves tissue perfusion. These new plasma expanders promote tissue perfusion, increasing oxygen delivery capacity without increasing blood oxygen-carrying capacity, thus treating the effects of anemia while avoiding the transfusion of blood.
Oxygen delivery capacity during profoundly anemic conditions depends on blood's oxygen-carrying capacity and cardiac output. Oxygen-carrying blood substitutes and blood transfusion augment oxygen-carrying capacity, but both have given rise to safety concerns, and their efficacy remains unresolved. Anemia decreases oxygen-carrying capacity and blood viscosity. Present studies show that correcting the decrease of blood viscosity by increasing plasma viscosity with newly developed plasma expanders significantly improves tissue perfusion. These new plasma expanders promote tissue perfusion, increasing oxygen delivery capacity without increasing blood oxygen-carrying capacity, thus treating the effects of anemia while avoiding the transfusion of blood.
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