Fluosol-DA as a Red-Cell Substitute in Acute Anemia

We assessed the safety and efficacy of Fluosol-DA as a red-cell substitute in acute anemia. Twenty-three surgical patients with blood loss and religious objections to receiving blood transfusions were evaluated. Fifteen moderately anemic patients with a mean hemoglobin level (±SE) of 7.2±0.5 g per deciliter had no evidence of a physiologic need for increased arterial oxygen content and did not receive Fluosol-DA. Eight severely anemic patients with a mean hemoglobin level of 3.0±0.4 g per deciliter met the criteria of need and received the drug until the physiologic need disappeared or a maximal dose of 40 ml per kilogram of body weight was reached. We observed no adverse reactions to Fluosol-DA. The average peak increment in arterial oxygen content with the drug was only 0.7±0.1 ml per deciliter. There were no appreciable beneficial effects of Fluosol-DA, perhaps because of the small increase in arterial oxygen content, the brief half-life of the drug (24.3±4.3 hours), and the limited total dose. Six of the eight patients receiving Fluosol-DA died. One of the survivors received red-cell transfusions against his wishes, under a court order, after his total Fluosol-DA dose. Fourteen of the 15 moderately anemic patients survived. The data in this select group of patients refusing blood products suggest that, after blood loss, Fluosol-DA is unnecessary in moderate anemia and ineffective in severe anemia. (N Engl J Med 1986; 314:1653–6.) THE perfluorochemical emulsion Fluosol-DA, 20 percent, is an acellular oxygen carrier that has been under investigation for use in acutely anemic patients who refuse blood transfusions. 1 2 3 4 5 Numerous laboratory studies have documented that Fluosol-DA will effectively load and unload oxygen when the recipients breathe supplemental oxygen. 6 7 8 9 10 Several of the clinical studies have suggested that the drug may provide an additional margin of safety in the perioperative period in acutely anemic patients. None of the published reports, however, have addressed the more critical issue of improved survival at potentially lethal levels of anemia. 3 The purpose of the present study was (1) to . . .