Abstract

~T PRESENT, NO RBC substitute can function .n. as efficiently as the natural red blood cell in the delivery of oxygen to tissues. Nevertheless, there are two promising RBC substitutes available: modified hemoglobin and fluorocarbons. This re­ view covers the present status of modified hemo­ globin as an oxygen-carrying blood substitute. Why is it necessary to modify hemoglobin? He­ moglobin is the natural oxygen carrier. Unfortu­ nately, there are a number of problems with cell­ free hemoglobin. Amberson shows that red cell hemolysates cause nephrotoxicity. 1 Rabiner et al show that this nephrotoxicity was due to the pres­ ence of the RBC stroma in the hemoglobin solution. 2 Removal of the red cell stroma to form stroma-free hemoglobin results in less nephrotox­ icity. However, as described below, there are other major problems with the in vivo use of stroma-free hemoglobin.3-5 1. Hemoglobin in the RBC exists as a tetramer.

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