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Potential Toxicity of an Oxygen-Carrying Substitute

Thomas S. Velky, Jr, MD; Edward S. Lee; Paul W. Maffuid, MS; Gary T. Robinson, MD; James C. Yang, MD; A. Gerson Greenburg, MD, PhD

Arch Surg. 1987;122(3):355-357.

Abstract
• The efficacy of stroma-free hemoglobin (SFH) as an oxygen-carrying red blood cell substitute in shock and trauma remains inconclusive. A major problem is the retention of sufficient intravascular persistence. The sites and mechanisms for clearance of SFH or its chemically modified variants are not well characterized. Capillary leakage has been reported. Any significant leak into the peritoneal cavity may be toxic, especially if bacteria are present. The present study quantitates peritoneal accumulation of SFH and chemically modified adenosine triphosphate (ATP)–SFH following a 50% exchange transfusion in rats. m-Dansyl cadaverine, an endocytotic blocking agent, was studied for its ability to alter accumulation of hemoglobin in the peritoneum. Differences in renal clearance corresponded to differences in vascular half-life of SFH (90 minutes) and ATP-SFH (210 minutes). Peritoneal leakage was not related to vascular persistence. We found that MDC significantly decreases the peritoneal accumulation of ATP-SFH but not that of SFH. We also noted that MDC neither inhibits nor alters renal clearance of either hemoglobin variant. Total peritoneal leakage is, at most, 4% of infused SFH at four hours. Molecular size and charge might be factors important in hemoglobin transport from the vasculature to the peritoneum.

(Arch Surg 1987;122:355-357)

Author Affiliations
From the Departments of Surgery, Veterans Administration Medical Center—San Diego and University of California—San Diego (Drs Velky, Robinson, and Yang, and Messrs Lee and Maffuid); and The Miriam Hospital and Brown University, Providence, RI (Dr Greenburg). Dr Velky was the winner of the 1986 Resident Prize Competition of the Association of Veterans Administration Surgeons.

Footnotes
Accepted for publication Sept 19, 1986.

Read before the Tenth Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Washington, DC, May 8, 1986.

Reprint requests to Department of Surgery, Room 112, Veterans Administration Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161 (Dr Velky).

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