BOVINE HEMOGLOBIN-BASED OXYGEN CARRIER FOR PATIENTS UNDERGOING HEMODILUTION BEFORE LIVER RESECTION

We have studied the use of ultrapurified polymerized bovine haemoglobi n (HBOC-201) in patients undergoing preoperative haemodilution before liver resection. After autologous blood donation of 1 litre, 12 patien ts (six males, six females, mean age 59 (35-69) yr) received Ringer's lactate solution 2 litre and, in a random design, 6% hydroxyethyl star ch 70 000/0.5 (HES) 3 ml kg(-1) or HBOC-201 0.4 g kg(-1) within 30 min . Blood samples were obtained for blood chemistry, co-oximetry, haemat ology, coagulation profiles and immunology examinations before operati on, on the day of surgery, on days 2-4 and 7 after operation, on the d ischarge day and 3 months after operation. There were no differences i n patient characteristics, blood loss, amount of solutions infused, tr ansfused allogeneic blood or duration of hospital stay. There were no local or systemic allergic reactions with infusion of HES or HBOC-201. Patients receiving HBOC-201 developed more pronounced leucocytosis an d reticulocytosis during the early postoperative days compared with HE S-treated patients. The mean maximum plasma haemoglobin concentration was 1.0 (so 0.2) g dl(-1) at the end of infusion of HBOC-201. The mean intravascular half-life of HBOC-201 was 8.5 h. Patients in both group s experienced temporary changes in liver enzymes and coagulation varia bles which returned to normal before discharge. Urinalysis revealed no difference between groups and no free haemoglobin was detected in uri ne. Patients receiving HBOC-201 showed no IgE and only a slight increa se in IgG titres to HBOC-201 on the day of discharge; these were not d etectable at 3 months. Single-dose administration of HBOC-201 was well tolerated by patients undergoing elective liver resection surgery and appears to be safe as a substitute during preoperative haemodilution.