Substitute blood trial worries ethicists

[wdlove]

Boston paramedics could begin giving severely injured patients an experimental blood substitute without their consent this summer, as part of a national effort to improve the survival chances of victims of car accidents, gunshot wounds, and other injuries that cause profuse bleeding.

Under the experiment, which still requires approval from the ethics panel at Boston Medical Center, randomly selected trauma patients would immediately receive infusions of PolyHeme, a blood-based product that doesn't spoil as easily as natural blood. In early tests, PolyHeme has kept some patients alive even when they have lost virtually all their own blood. Paramedics normally administer saline solution, because blood breaks down quickly when it's not refrigerated.

http://www.boston.com/news/local/articles/2004/02/21/substitute_blood_trial_worries_ethicists/

 

[phrancpharmD]

Re: Substitute blood trial worries ethicists

At an accident scene, the rescue squad "doesn't ask you if you want to be removed from your car" or be given cardiopulmonary resuscitation, said Dr. Richard Gamelli, who will lead the PolyHeme research at Loyola University Medical Center in Illinois if it is approved there. "We kind of have a social contract to do the right thing already."

I agree. Plus, the substitute seems physiologically inert and quite safe. Aren't there already "workarounds" for emergent procedures where consent can not be obtained? I wonder if the same could apply to this. . .

 

[rainman::|:|]

Re: Re: Substitute blood trial worries ethicists

Originally posted by phrancpharmD
I agree. Plus, the substitute seems physiologically inert and quite safe. Aren't there already "workarounds" for emergent procedures where consent can not be obtained? I wonder if the same could apply to this. . .

Yes, consent does not have to be obtained in this case, and the ethics have already been debated-- medicines have been tested in this fashion many times before, it's the only way to properly test EMT supplies. There is no news about ethics here. Just a promising new blood substitute.

paul

 

[phrancpharmD]

Re: Re: Re: Substitute blood trial worries ethicists

Originally posted by paulwhannel
Yes, consent does not have to be obtained in this case, and the ethics have already been debated-- medicines have been tested in this fashion many times before, it's the only way to properly test EMT supplies. There is no news about ethics here. Just a promising new blood substitute.

paul

Wow, good to know. I never thought of it that way. Thanks Paul!

 

[Doctor Q]

Blood substitutes will eventually solve the problem that there are never enough blood donors to keep up with demand. Sometimes, in times of blood shortages, patients and doctors and hospitals make medical decisions based on the supply, such as postponing elective surgery, and this makes the patient's treatment less than the ideal. When blood can be made in the lab, we'll all be better off.

This particular blood substitute (PolyHeme) is derived from human hemoglobin and starts from a blood donation, which the manufacturer has bought from the usual suppliers such as the American Red Cross. Here's more info about it.

I'm curious how many units of PolyHeme they can make from one unit of donated blood.

 

[rainman::|:|]

Originally posted by Doctor Q
I'm curious how many units of PolyHeme they can make from one unit of donated blood.

if this stuff is as good as it claims, eg being able to remain unrefrigerated for long periods of time, and being compatable with any blood type, i'd say that ratio can be pretty high-- a lot of blood donated today goes to waste because it couldn't be used in time, it is inviable so quickly. If all donated blood went into making this stuff, a universal supply could be created and cities could begin to stockpile it. Hell, the red cross could have caches in unstable areas that might not be able to sustain a natural disaster, such as iran (which recently had a blood shortage after the earthquake and it's aftershocks)...

the reason a handful of people are complaining is that a similar fluid was tested in the mid-90s with poor success, and a few peoples' families are claiming that the stuff killed them. There's not a lot of proof that that's what happened, and IMHO it would have happened anyway...

i would personally have no problem with this stuff being used on me, if i had a car accident or something... after a point, saline solution can't do the job, and i'd rather take a risk than bleed out in the ambulance.

paul

 

[Doctor Q]

The article I linked to above says

Jehovah’s Witnesses, whose religious beliefs prohibit blood transfusions, may accept “fractions of any of the primary components” of blood, opening the door to the use of hemoglobin based blood substitutes like PolyHeme.

I've never understood this belief, which is based on a literal reading of the biblical passages where Noah and Moses are instructed "But you shall not eat flesh in its life: the blood." The admonition was apparently an instruction to bleed animals properly, but the literal interpretation led to the assumption that blood = life and taking another's blood = taking another's life.

Since PolyHeme is still based on human blood, I don't see how it solve this problem, which has led to many court cases, especially where a parent is making medical decisions for a child, but I'm glad that there is hope that treating Witnesses and others with such beliefs may become possible without all the controversy and conflict.

 

[wdlove]

I certainly hope that the PolyHeme trial will be successful this summer here in Boston. In the cause of traumatic injury where there is great blood loss there if great need for blood at the scene. The body needs moire than just fluid replacement it needs oxygen for cells to survive.

The idea that PolyHeme is universally compatible, will mean a great thing when it comes to typing problems. Hopefully they can also increase the length of time that PolyHeme survives in the human body. It also says that PolyHeme lasts in the body for 72 hours. Transfused blood also lasts in the body a shorter time than natural blood.

http://www.clarian.org/health/announcements/012104_polyheme.jhtml