Paul M. Ness, MD

Based upon increased concerns about the infectious and noninfectious risks of blood transfusions, physicians are now encouraged to use drugs in favor of blood components. Patients with von Willebrand’s disease are given DDAVP rather than cryoprecipitate to improve hemostasis, fibrinolytic inhibitors have been used in high blood loss surgeries, hematopoietic growth factors are administered to prevent or treat perioperative anemia, and new agents such as recombinant Factor VIIa have been used off-label for a growing list of hemorrhagic conditions. Older agents such as vitamin K and fibrin sealants are increasingly being used as adjunctive therapy for bleeding and hemorrhagic prophylaxis.

Recent articles and editorials in the Journal of the American Medical Association and HemOnc Today have documented the safety concerns with hemoglobin-based oxygen carriers. Data from the evolving clinical trials have suggested a profile of adverse effects, perhaps due to nitric oxide scavenging, that have led some clinicians to suggest that there is no role for hemoglobin-based oxygen carriers, more commonly called a blood substitute, since current blood supplies are so safe.