Hemoglobin substitutes

Eur Spine J. 2004 Oct;13 Suppl 1(Suppl 1):S76-82. doi: 10.1007/s00586-004-0737-x. Epub 2004 May 27.


Orthopaedic patients frequently require blood transfusions to treat peri-operative anemia. Research in the area of hemoglobin substitutes has been of great interest since it holds the promise of reducing the reliance on allogeneic blood transfusions. The three categories of hemoglobin substitutes are (1) cell-free, extracellular hemoglobin preparations made from human or bovine hemoglobin (hemoglobin-based oxygen carriers or HBOCs); (2) fluorine-substituted linear or cyclic carbon chains with a high oxygen-carrying capacity (perfluorocarbons); and (3) liposome-encapsulated hemoglobin. Of the three, HBOCs have been the most extensively studied and tested in preclinical and clinical trials that have shown success in diminishing the number of blood transfusions as well as an overall favorable side-effect profile. This has been demonstrated in vascular, cardiothoracic, and orthopaedic patients. HBOC-201, which is a preparation of cell-free bovine hemoglobin, has been approved for clinical use in South Africa. These products may well become an important tool for physicians treating peri-operative anemia in orthopaedic patients.

Publication types

  • Review

MeSH terms

  • Anemia / etiology
  • Anemia / therapy*
  • Animals
  • Blood Substitutes / chemistry
  • Blood Substitutes / pharmacology
  • Blood Substitutes / therapeutic use*
  • Blood Transfusion / methods*
  • Calmodulin / pharmacology
  • Calmodulin / therapeutic use
  • Erythrocytes / physiology
  • Hemoglobins / chemistry
  • Hemoglobins / pharmacology
  • Hemoglobins / physiology
  • Hemoglobins / therapeutic use
  • Humans
  • Orthopedic Procedures / adverse effects*
  • Perioperative Care
  • Randomized Controlled Trials as Topic


  • Blood Substitutes
  • Calmodulin
  • HBOC rHB2.0, human
  • Hemoglobins
  • HBOC 201