Building a Better Substitute 

While both substitutes are oxygen carriers superior to banked human blood, the perfluorocarbon-based blood substitutes are less adept at carrying oxygen to the body than the hemoglobin-based substitutes. Treatments using perfluorocarbon-based substitutes also require patients inhale 100 percent oxygen — but tests indicate they don't increase blood pressure. Side effects are fairly insignificant, Spiess says: a drop in platelet counts in the first few hours and mild, flu-like symptoms about 12 hours after surgery. The liver also swells slightly for a few days after treatment, but tests show the liver returns to normal about five days after operation.

"There is no change in blood pressure, no change in heart rate, no effect on the kidney," Spiess says. "Patients who get it can have aches and pains and feel like they have a mild flu. But if you've just had surgery or you just had major brain trauma, you are going to feel like hell anyways."

Ultimately, Spiess says he envisions creating his own perfluorocarbon-based blood substitute in the labs at VCU. He'll have plenty of help. Across the hall, another colleague, Dr. Theresa Duane, assistant professor of surgery in the trauma division, is heading up stage-three clinical trials that will be completed within a year using another hemoglobin-based blood substitute, Polyheme, and the results could be a major breakthrough: The blood-pressure problems may have finally been worked out.

Duane says the results aren't in just yet. But the research at VCU Medical Center will play a key role in whether it ultimately passes muster with the FDA. — Scott Bass

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