To the Editor: The meta-analysis of cell-free hemoglobin-based blood substitutes and risk of myocardial infarction (MI) and death by Dr Natanson and colleagues1 and the accompanying Editorial by Drs Fergusson and McIntyre2 raise serious concerns for clinicians treating life-threatening anemia in South Africa, the only country where a hemoglobin solution (Hemopure, Biopure Corp, Cambridge, Massachusetts) is registered for clinical use.
Levien LJ, Hodgson RE, James MFM. Hemoglobin-Based Blood Substitutes and Risk of Myocardial Infarction and Death. JAMA. 2008;300(11):1295–1299. doi:10.1001/jama.300.11.1295-a
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