Perfluorocarbons in the twenty-first century: clinical applications as transfusion alternatives

The risks of allogeneic transfusion are well known to physicians and have prompted a search for alternatives. Perfluorocarbons were introduced into clinical trials in the early 1980's with the hope that these products would develop into acceptable blood substitutes. Unfortunately, the limited potency, short half-life, and potential toxicity of these early formulations coupled with unrealistic expectations for efficacy prevented the perfluorocarbons from playing a significant role in transfusion medicine. Recent changes in formulation to improve efficacy and eliminate toxicity have stimulated renewed interest in perfluorocarbons as alternatives to allogeneic transfusion. Our recent work has focused on the role of perfluoroctylbromide (PFOB), a second generation perfluorocarbon, as an adjunct to autologous transfusion and acute normovolemic hemodilution (ANH), rather than as a total blood substitute. Initial animal experiments have shown the ability of small doses of PFOB to maintain oxygen delivery without the need for blood transfusion in the setting of hemodilution. Our presentation will focus on subsequent clinical work using PFOB as an alternative to both allogeneic and autologous blood transfusion during ANH. We believe that perfluorocarbons such as PFOB will have a significant role in the future as one of several, additive alternatives to blood transfusion.