Research Paper On Discussing Synthetic Blood In Pre-Hospital Settings
There is a screeching sound, bright lights, everything is spinning, you feel pain and then silence. This is the description of a car accident; an event that occurs hundreds, if not thousands of times per day all over the world. People are critically injured, bleeding profusely, and life is ebbing away. The first responders, EMS and paramedics, know that these patients are in need of transfusions to restore the blood they have lost. However, the hospital is several miles and many minutes away and the victims may not survive the transport. In the face of accidents, natural, disasters, and victims of crimes immediate, on site, transfusions would, could, and have been successful as a means of maintaining and stabilizing the patient’s condition, making their survival far more likely. Unfortunately, there is simply not enough blood donated to accommodate for the supplies in demand at hospitals and those that would be needed for pre-hospital settings (Brown University, 2005). However, the solution can be and is being found in the use of synthetic blood products. Research and experts continue to debate the pros and cons. All the same the United States has been testing different synthetic alternatives and there is little doubt in the researchers minds that these alternatives can and will be an active part of the America, and the world’s, medical future.
The blood in the body is form of connective tissues that contains four major parts. Plasma is the foundation, made of water, salts and proteins. Within the plasma there are platelets, white blood cells and red blood cells, each performing a certain function. Platelets help to clot the blood at point of injury, the white blood cells support the immune system and red blood cells aid in the transport of oxygen and carbon dioxide through the body. Blood is a basic necessity of life. Its importance to health and life has been a relevant problem since people began seriously injury themselves, and at times of war. Historically the idea of finding a substitution for blood is not, solely, a modern concept. The first blood transfusion was performed in 1667, however, the practice was abandoned when the bulk of the recipients died; this may had to do with rejection and blood incompatibility (Sarkar, 2008). However, once science understood the nature, properties, and structure of blood, transfusions are a common medical practice in today’s society. Unfortunately, blood to transfuse is not always in high supply. Meeting that demand can be overwhelming. Statistics average that a blood transfusion is needed every 2 seconds in the United States. To meet that demand 41,000 pints of blood must be donated and available every single day. Granted not everyone makes a good potential donor, it is estimated that only 38% are proper candidates; however, only approximately, 10% actually donate the much needed blood. Of course it is individuals with type O-negative are considered universal donors and there is little or no risk of rejection regardless of the recipient’s blood type (Winter, 2013). With the limited availability and low donation rates, it is no surprise that substitutes have been considered for a long time. That said having blood alternatives that can be administered on the scene of an accident or in the persons home prior to or during transport, would beneficial to that patients and improve their chances of survival.
Present day trials have shown promising results. Mice that have been regularly transfused with blood alternatives and, as yet, shown no rejection, complications, or toxic reactions. There are a few types of synthetic blood options either presently being tested or already on the market. Oxiglobin, for example, is the only blood substitute that has been approved for the use in veterinary clinics; as yet all uses have been successful. The two types considered and desired for human use are hemoglobin-based oxygen carriers (HBOCs) and perflourocarbons (PFCs). HBOCs are based in natural, sterilized hemoglobin, often derived from hemoglobin donated by cadavers or from slaughtered animals, like cattle. The second form are perflourocarbons, which is of an entirely synthetic in origin, derived from the chemicals fluorine and carbon. These adapted molecules are adept at aiding in the transport of oxygen throughout the body in an efficient manner similar to genuine blood (Brown University, 2005). There are many benefits to the use of these synthetic blood alternatives, especially, in emergency settings in the field, but there are some specific negative aspects as well.
The benefits of blood alternatives, in general include, there are no needs for advance planning, it is ready to use, has a longer shelf life than donated blood, does not require refrigeration and it is a universal substitute, not deterred by differing blood types. However, in a diverse world, it also, opens transfusions that are agreeable to individuals, like Jehovah Witnesses, who are not comfortable accepting blood from another person, but the synthetic alternatives are acceptable. There is also the issue of the lifesaving potentials that such alternatives could create in the field. In pre-hospital settings, people can be gravely injured, seconds from dying, and these synthetic, easy-to-administered synthetics could help to balance out their systems and postpone their death, ideally buying time until they reach the hospital (Brown University, 2005). In the last few decades we have seen warfare abroad and accidents, explosions, gun assaults, and natural disasters that have left victims whose blood loss is so severe that transporting them is essentially pointless. However, with access to synthetic blood treatment it could literally change the saddening statistics and save real lives.
Of course, there are two sides to every issue, every idea, and every invention. There are some disadvantages and side effects that must be considered and discussed. In the case of PFCs there are still studies being conducted to determine if there are any long-term or negative effects of this particular blood substitute. As yet, no serious toxicity has been determined, however, in some rodent experiments, there were some mice that developed unforeseen thyroid and liver conditions. There is no direct link between the synthetic blood and these health issues experienced by the mice. Human trials have been incredibly promising. At this point this first generation, synthetic blood alternative, has greater benefits than dangers. In fact, PFCs are such fantastic oxygen carriers it is being considered in the treatment of severe brain traumas. It should be noted that after administration the patient may experience some flu-like symptoms. There are a few more serious challenges involved with HBOCs; Again, availability is an issue. This is important is because the base requires donated hemoglobin. Even though all genetic markers and the like have been processed out of the blood product, there is still the change of a negative immunological response by the recipient (Brown University, 2005). Some patient’s may still reject an HBOC once administered. Finally, there is the possibility of some gastrointestinal issues and a reddish tinge may appear on the skin and in the eyes of the recipient.
All synthetic blood alternatives do not remain as effective in the body for as long as a traditional human to human transfusion. HBOCs, for example, only functions in the body for 20-30 hours as opposed to blood transfusion, which can last for, sometimes, 34 days (Sarkar, 2008). However, in the meantime, this may not make HBOC’s the ideal solution to long-term transfusion at this time, but it makes an ideal solution for emergency situations and pre-hospital settings. These alternatives have the potential to make certain that the recipient will, at the very least, remain stable enough to transport and a more realistic assumption of survival. Think about all of the mass disasters, plane crashes, and hiking accidents that are strewn all over the media. These victims are often far from medical care and facilities capable of addressing their injuries. Efforts by many rescuers, including fire department, EMS, and helicopter transport would be more effective if they can stabilize and transfuse their patient’s with the blood product they need to keep them alive. Implemented in the field, synthetic blood products are the ideal means for first responders to lower the number of deaths that they are witness to and have a real opportunity to save lives in a practical and feasible way. However, naysayers still argue that synthetic blood transfusions in the field, may only lead to greater risk of heart attack, which places the victim in greater health danger, which is hardly better (Søreide & Deakin, 2005). However, presently, studies are showing that when used as a triage element in order to successfully transport the patient to a formal hospital is ideal. The risk of heart attack is hardly relevant in such a short and temporary matter of time.
The future is very bright in the area of synthetic blood research and development. There are new alternatives being considered each and every day. These efforts extend to improving existing alternatives and to discovery new alternatives that may be even more efficient. It is not just the United States, obviously, interested in the development of blood alternatives that may be implemented in pre-hospital situation. In the United Kingdom a number of countries are participating in similar research (Maloney, 2014). The University of Edinburgh, for example, along with the Scottish National Blood Transfusion Service, are currently studying induced pluripotent stem cells, or iPSCs, which is derived from “dedifferentiating fibroblasts from an adult donor and reprogramming them into induced pluripotent stem cells” (Akst, 2014). These cells can then be harvested from the bone marrow-like environment after, approximately, a month. Ideally, the development of cultured, synthetic blood could be a solution to many of the issues involved with availability.
Today science and medicine knows so much more than it has in previous era. Scientific and technological advances have been evolved that have benefitted human life. The one thing that cannot be controlled, at least not yet, by the medical community is the inevitability of death eventually, however, it can help to prevent it when it occurs unnaturally. Accidents, criminal assaults, and natural disasters threaten human life everyday somewhere in the world. Out in the world, everyone knows that bleeding severely and being far from medical care is life threatening, so to have the alternatives and appropriate procedures to use synthetic blood alternatives in pre-hospital settings as part of the triage and emergency care is necessary and practical; Ideally, prolonging and saying lives.
Akst, J. (2014, April 6). Artificial blood is patient-ready. The Scientist Magazine, 1.
Maloney, D. (2014, June 14). Real-life true blood: Synthetic blood is coming — and so are a host of potential complications. Wired Magazine, 1.
Sarkar, S. (2008). Artificial blood. Indian Journal of Critical Care Medicine, 12(3), 140-144.
Søreide, E., & Deakin, C. D. (2005). Pre-hospital fluid therapy in the critically injured patient–—a clinical update. Injury, Int. J. Care Injured, 36, 1001-1010.
Winter, L. (2013, November 1). The first trial results of artificial blood use are encouraging. IFL Science, 1. Retrieved from http://www.iflscience.com/health-and-medicine/first-trial-results-artificial-blood-use-are-encouraging
Brown University. (2005). Synthetic blood. Brown University, 1. Retrieved from http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/10/webpages/HBOClink.htm
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