Document Detail


Isovolemic exchange transfusion with increasing concentrations of low oxygen affinity hemoglobin solution limits oxygen delivery due to vasoconstriction.
MedLine Citation:
PMID:  18835914     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
O2-carrying fluids based on hemoglobin (Hb) are in various stages of clinical trials to determine their suitability as O2-carrying plasma expanders. Polymerized Hb solutions are characterized by their vasoactivity, low O2 affinity, oncotic effect, prolonged shelf life, and stability. Physiological responses to facilitated O2 transport after exchange transfusion with polymerized bovine Hb (PBH) were studied in the hamster window chamber model during acute moderate anemia to determine how PBH affects microvascular perfusion and tissue oxygenation. The anemic state [29% hematocrit (Hct)] was induced by hemodilution with a plasma expander (70 kDa dextran). After hemodilution, animals were randomly assigned to different exchange transfusion groups. Study groups were based on the concentration of PBH used, namely: PBH at 13 g Hb/dl [PBH13], PBH diluted to 8 (PBH8) or 4 (PBH4) g Hb/dl in albumin solution at matching colloidal osmotic pressure (COP), and no PBH (only albumin solution) at matching COP (PBH0). Measurement of systemic parameters, microvascular hemodynamics, capillary perfusion, and intravascular and tissue O2 levels was performed at 18% Hct. Restitution of O2-carrying capacity with PBH13 increased arterial pressure and triggered vasoconstriction, low perfusion, and high peripheral resistance. PBH4 and PBH0 exhibited lower arterial pressures compared with PBH13. Exchange transfused animals with PBH8 and PBH4 better maintained perfusion and functional capillary density than PBH13. Blood gas parameters and acid-base balance were recovered proportional to microvascular perfusion. Arterial O2 tensions were improved with PBH4 and PBH8 by preventing O2 precapillary release and increasing O2 reserve. Further studies to establish PBH optimal dosage, efficacy, safety, and its effect on outcome are indicated before Hb-based O2-carrying blood substitutes are implemented in routine practice.
Authors:
Pedro Cabrales; Amy G Tsai; Marcos Intaglietta
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-10-03
Journal Detail:
Title:  American journal of physiology. Heart and circulatory physiology     Volume:  295     ISSN:  0363-6135     ISO Abbreviation:  Am. J. Physiol. Heart Circ. Physiol.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-10     Completed Date:  2008-12-22     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  100901228     Medline TA:  Am J Physiol Heart Circ Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  H2212-8     Citation Subset:  IM    
Affiliation:
La Jolla Bioengineering Institute, University of CAlifornia, San Diego, La Jolla, CA, USA. pcabrales@ucsd.edu
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MeSH Terms
Descriptor/Qualifier:
Anemia / blood,  chemically induced,  physiopathology,  therapy*
Animals
Blood Substitutes / metabolism,  pharmacology*
Blood Volume / drug effects*
Cricetinae
Dextrans
Disease Models, Animal
Erythrocytes / drug effects,  metabolism
Hematocrit
Hemodilution
Hemoglobins / metabolism,  pharmacology*
Hydrogen-Ion Concentration
Male
Mesocricetus
Microcirculation / drug effects*
Osmotic Pressure
Oxygen / blood*
Plasma Exchange
Polymers / metabolism,  pharmacology*
Skin / blood supply*
Vasoconstriction*
Grant Support
ID/Acronym/Agency:
P01 HL-071064/HL/NHLBI NIH HHS; R01-HL-62318/HL/NHLBI NIH HHS; R01-HL-62354/HL/NHLBI NIH HHS; R01-HL-76182/HL/NHLBI NIH HHS; R24-HL-64395/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Blood Substitutes; 0/Hemoglobins; 0/Polymers; 0/polymerized bovine hemoglobin; 7782-44-7/Oxygen; 9004-54-0/Dextrans
Comments/Corrections

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