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September 17, 2008

Hemoglobin-Based Blood Substitutes and Risk of Myocardial Infarction and Death

JAMA. 2008;300(11):1295-1299. doi:10.1001/jama.300.11.1297-a

To the Editor: We agree with the Editorial by Drs Fergusson and McIntyre1 that an artificial blood substitute must be “safe, effective, and universally available.” Yet we find that their affirmation that the US blood supply is “adequate and safe” problematic.

According to the America's Blood Centers Web site,2 only 53 of their 93 associated centers have a supply for 3 days or more (52% of their network blood supply). Infectious diseases threats to the blood supply (such as hepatitis B and C, HIV, West Nile virus, and variant Creutzfeldt-Jakob disease) that have led to increased complexity of donor screening,2,3 the possibility of national emergencies, and circumstances in which stored blood is not acceptable or viable (eg, cultural/religious impediments, cross-matching incompatibility), as well as adverse immunoinflammatory effects of stored blood transfusions despite leukoreduction,4 require that risks potentially associated with artificial blood substitutes be balanced against its potential benefits for specific populations and conditions. This is particularly germane to trauma patients, for whom there is an independent association between the use of packed red blood cell transfusions in the first 12 hours and the incidence of multiple organ failure.4