Transportadores artificiais de oxigênio como possível alternativa às células vermelhas na prática clínica
Palavras-chave:
Hemoglobinas, Anemia, Sangue, Transfusão de sangue, Substitutos sanguíneosResumo
Os fluidos de ressuscitação são utilizados para abolir os distúrbios microcirculatórios e restaurar a adequada oxigenação tissular. Os limites de segurança na prática da transfusão restrita são dados pela tolerância individual do paciente na anemia normovolêmica aguda. Os transportadores artificiais de oxigênio baseados no perfluorocarbono e na hemoglobina são opções atrativas para a transfusão alogênica de células vermelhas. Os riscos da transfusão sanguínea alogênica são muitos e incluem a transmissão de infecções, retardo na cicatrização pós-operatória, reações transfusionais, imunomodulação e risco de recorrência do câncer. Independentemente de os carreadores artificiais de oxigênio estarem disponíveis para o uso clínico rotineiro, mais estudos são necessários para mostrar a segurança e a eficácia dessas substâncias na prática clínica.
Downloads
Referências
Brunskill S, Prowse C, Garrioch M, et al. Blood substitutes for avoiding allogeneic blood transfusion. The Cochrane Library. Available from: http://mrw.interscience.wiley.com/co- chrane/clsysrev/articles/CD004894/frame.html. Accessed in 2009 (Feb 3).
Henkel-Honke T, Oleck M. Artificial oxygen carriers: a current review. AANA J. 2007;75(3): 205-11.
Amberson WR, Jennings JJ, Rhode CM. Clinical experience with hemoglobin-saline solutions. J Appl Physiol. 1949;1(7):469-89.
Nouwairi NS. The risks of blood transfusions and the shortage of supply leads to the quest for blood substitutes. AANA J. 2004;72(5):359-64.
Creteur J, Vincent JL. Hemoglobin solutions. Crit Care Med. 2003;31(12 Suppl):S698-707.
Jahr JS, Walker V, Manoochehri K. Blood substitutes as pharmacotherapies in clinical prac- tice. Curr Opin Anaesthesiol. 2007;20(4):325-30.
Pape A, Habler O. Alternatives to allogeneic blood transfusions. Best Pract Res Clin Anaes- thesiol. 2007;21(2):221-39.
Messmer KF. Acceptable hematocrit levels in surgical patients. World J Surg. 1987;11(1): 41-6.
Spahn DR, Casutt M. Eliminating blood transfusions: new aspects and perspectives. Anes- thesiology. 2000;93(1):242-55.
Habler OP, Messmer KF. The physiology of oxygen transport. Transfus Sci. 1997;18(3):425-35.
Cain SM. Oxygen delivery and uptake in dogs during anemic and hypoxic hypoxia. J Appl Physiol. 1977;42(2):228-34.
Carson JL, Duff A, Poses RM, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348(9034):1055-60.
Brander L, Reil A, Bux J, Taleghani BM, Regli B, Takala J. Severe transfusion-related acute lung injury. Anesth Analg. 2005;101(2):499-501.
Landers DF, Hill GE, Wong KC, Fox IJ. Blood transfusion-induced immunomodulation. Anesth Analg. 1996;82(1):187-204.
Weber EW, Slappendel R, Prins MH, van der Schaaf DB, Durieux ME, Strümper D. Periope- rative blood transfusions and delayed wound healing after hip replacement surgery: effects on duration of hospitalization. Anesth Analg. 2005;100(5):1416-21.
Habler O, Pape A, Meier J, Zwissler B. Künstliche Sauerstoffträger als Alternative zur Blut- transfusion. [Artificial oxygen carriers as an alternative to red blood cell transfusion]. Anaes- thesist. 2005;54(8):741-54.
Spahn DR, Kocian R. The place of artificial oxygen carriers in reducing allogeneic blood trans- fusions and augmenting tissue oxygenation. Can J Anaesth. 2003;50(6 Suppl):S41-7.
Wahr JA, Trouwborst A, Spence RK, et al. A pilot study of the effects of a perflubron emulsion, AF 0104, on mixed venous oxygen tension in anesthetized surgical patients. Anesth Analg. 1996;82(1):103-7.
Spahn DR, Leone BJ, Reves JG, Pasch T. Cardiovascular and coronary physiology of acute isovolemic hemodilution: a review of nonoxygen-carrying and oxygen-carrying solutions. Anesth Analg. 1994;78(5):1000-21.
Dietz NM, Joyner MJ, Warner MA. Blood substitutes: fluids, drugs, or miracle solutions? Anesth Analg. 1996;82(2):390-405.
Stowell CP. What happened to blood substitutes? Transfus Clin Biol. 2005;12(5):374-9.
Moore EE. Blood substitutes: the future is now. J Am Coll Surg. 2003;196(1):1-17.
Migita R, Gonzales A, Gonzales ML, Vandegriff KD, Winslow RM. Blood volume and cardiac index in rats after exchange transfusion with hemoglobin-based oxygen carriers. J Appl Phy- siol. 1997;82(6):1995-2002.
Spahn DR, Kocian R. Artificial O2 carriers: status in 2005. Curr Pharm Des. 2005; 11(31):4099-114.
Gould SA, Moore EE, Hoyt DB, et al. The first randomized trial of human polymerized he- moglobin as a blood substitute in acute trauma and emergent surgery. J Am Coll Surg. 1998;187(2):113-20; discussion 120-2.
Spahn DR, Waschke KF, Standl T, et al. Use of perflubron emulsion to decrease allogeneic blood transfusion in high-blood-loss non-cardiac surgery: results of a European phase 3 study. Anesthesiology. 2002;97(6):1338-49.
Hable O, Kleen M, Pape A, Meisner F, Kemming G, Messmer K. Diaspirin-crosslinked hemo- globin reduces mortality of severe hemorrhagic shock in pigs with critical coronary stenosis. Crit Care Med. 2000;28(6):1889-98.
Issues in Emerging Health Technologies. Oxygen carriers (“blood substitutes”). Canadian Agency for Drugs and Technologies in Health. 2001;21:1-6. Available from: http://www. acmts.ca/media/pdf/151_oxygencarriers_cetap_e.pdf. Accessed in 2009 (Feb 3).
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
