Synthetic blood first

[mr friendly guy]

http://www.news.com.au/national/revolut ... 6050144062

AN Australian woman's life has been saved using a radical synthetic blood substitute made from cow plasma.

In a world first, doctors at The Alfred Hospital in Melbourne brought 33-year-old Tamara Coakley back from the brink after a car crash left her with severe blood loss and close to heart failure.

Her spinal cord was almost severed, her lungs collapsed, her skull was fractured, several ribs were broken, as were her cheekbone and an elbow, and her spleen was ruptured.

She was barely alive when she arrived at hospital.

"I had one litre of blood left in my body," she said.

In a last-ditch effort to save Ms Coakley's life, 10 units of the haemoglobin-based oxygen carrier HBOC201 were flown in from the US.

The synthetic contains a molecule derived from cow plasma and restored her levels of haemoglobin, which carries oxygen to the tissues.

Associate Professor Mark Fitzgerald said it marked an important step in the development of a viable blood alternative to address worldwide blood supply shortages.

Unlike donor blood, it does not require crossmatching and can be stored without refrigeration for up to three years.

"It's a bit of science fiction," Dr Fitzgerald said.

As a Jehovah's Witness, Ms Coakley was unable to have blood transfusions but was allowed blood substitutes.

Dr Fitzgerald was familiar with the product being developed by the US Navy because he gave independent advice on a proposed research project five years ago.

Working through the night, he negotiated with the drug manufacturer, OPK Biotech, the Therapeutic Goods Administration, the Australian Quarantine and Inspection Service and airline carriers.

The Alfred's ethics committee gave the import the green light, permission was granted under the TGA's special access scheme and the manufacturer paid the bill.

HBOC201 is one of a number of blood substitutes being developed around the world.

University of Melbourne Head of Department of Paediatrics Professor Paul Monagle said synthetic blood could address donor supply issues and give people in remote areas access to life-saving treatments.

Professor Monagle said any synthetic blood product would have to undergo rigorous testing before it moved from prototype to routine practice.

Ms Coakley, who was in an induced coma during the crucial medical procedure, knows how close she came to death.

"They did everything they could, I am so grateful."

For more on the woman who was brought back from the brink of death by a synthetic blood transfusion go to The Daily Telegraph.

Can't comment right now, off to work. But science, fuck yeah.

[Eternal_Freedom]

I think "science, fuck yeah" kinda says it all really.

[madd0ct0r]

10 units?

units of what?

I'm impressed they got it from USA to Melbourne fast enough.

[PeZook]

10 units?

units of what?

Of blood. It's a medical thing, they vary country to country but one unit is usually about 400-500ml as far as I know.

I guess the reason for that nomenclature is that's easier to say "2 units" or "3 units" instead of "1.5 litres of blood right now!" when you're trying to save a patient in the ER. Conventions like these also probably help prevent misunderstandings by the stressed guy/gal running to get the blood. He's not thinking "1.5 of what?", because saying "X of blood" refers to these "units".

Of course I might be wrong.

[Serafina]

Quite correct, units are widely used in medical practice. Tough i'd like to note that there are different units for different stuff - "three units of morphine" are not the same as "three units of blood" or "three units of some other drug". The one might refer to milliliters (of one substance), the other to half a liter (of another substance) etc.
The reason why this is not confusing and why it is used is quite simple:
The amount of drug/whatever in a unit is calculated according to it's usages. One unit of morphine might be good for a small amount of pain, three for a bad one and six are a critical dose a doctor does not want to cross *. It's much easier and faster to eyeball emergency treatments or the application of save drugs that way.

*Numbers pulled from thin air for the purpose of illustration. If you want to know exact figures or details, ask a doctor - my knowledge is second-hand from medical students and i don't want to make claims of things i do not know enough about.


I really hope those blood-substitutes will work out. They will likely not be viable as a longer-term replacement for blood, and replacing most of your blood with them will still be bad because they will antibodies, white blood cells and other stuff.
But the important thing is that they can replace the respiratory function of the blood and give the body time to fill up it's own blood supply without asphyxiating. As long as they can do that, it'll be a another medical miracle and another victory for science.

[PeZook]

Yeah, exactly: even if a total substitute won't ever be available, it gives time to totally messed up patients. In that time you can either call up family members for a transfusion or let the body produce its own blood back to survivable levels. Also, you can keep the actual donor blood in the bank for when it's really really really needed. Isn't routine surgery the biggest consumer of blood? Replace that use with substitutes and you get a lot more for use on trauma victims.

That woman would've been dead just ten years ago, so I'd say they are already working out. I find that most medical science stuff is small steps rather than huge leaps, with applications of new tech first being tiny and specialized only to blow up into wide-scale usage some time later. Like synthetic skin or heart assistance pumps etc.

[Broomstick]

10 units?

units of what?

In this context, "units of blood substitute".

In the US, a "unit of blood" was originaly 1 pint. I believe that has not been standardized as 500 ml (which is almost the same amount anyway, just slightly more).

I'm impressed they got it from USA to Melbourne fast enough.

Me, too. In fact, I can't quite figure that.... she almost entirely bled out, but they kept her alive long enough for the stuff to be flown in from the US? Even using a private plane that goes faster than a commercial flight that would still take hours.

[PeZook]

In this context, "units of blood substitute".

In the US, a "unit of blood" was originaly 1 pint. I believe that has not been standardized as 500 ml (which is almost the same amount anyway, just slightly more).

Since it's designed to make eyeballing amounts easier, it doesn't really matter if it's 450, 500 or 550ml. I suppose drugs like morphine are more strict, and when out of the ER or other emergency situation, you default back to precise drug doses.

Me, too. In fact, I can't quite figure that.... she almost entirely bled out, but they kept her alive long enough for the stuff to be flown in from the US? Even using a private plane that goes faster than a commercial flight that would still take hours.

I'm far from an expert, but that's actually almost as impressive as the blood substitute itself. I wonder what made it possible.

[SCRawl]

It would be great if this could be used as a total replacement for donor blood. What I've heard is that even in an all-volunteer system like Canada's, a unit of blood costs a little north of $400, counting all the costs. Obviously with an artificial substitute you won't need to test for diseases, or (apparently) worry about having the right blood type, or convince people to come in and donate. I remember hearing about products like this twenty years ago, but this is the first time I've ever heard of it being used in a life-and-death situation.

[Hawkwings]

http://www.heraldsun.com.au/news/revolu ... 6050068016

Within 48 hours, the blood product had arrived in Melbourne and five units (2350ml) were painstakingly administered over two days.

A much more reasonable timeframe for a flight, but that just makes the fact that they kept her alive for so long even more amazing.

[PainRack]

A unit of blood doesn't have a fixed numerical value in ml.

[Rabid]

... Because each "pocket" of blood isn't filled the same :

Sometime when I give blood, i can give over 480 grammes of it, and another times it is only around 450 grammes. But it is still a whole unit of blood in each case, because it is one "bag", one "container" of blood. One "unit".


And, about the OP : Yay for science !

How have they managed to keep here alive ? Maybe they put here on hold ? That would make two revolutionary procedures in one (well, one revolutionary, and another still in its experimental phase).

[mr friendly guy]

The article mentioned she was close to heart failure, presumably from injuries to nearby structures like the lungs, and also via loss of blood forcing the heart to pump harder to circulate oxygen around (this is called high output heart failure as opposed to low output heart failure).

She was placed in an induce coma in an Intensive Care Unit, while they most likely kept her her blood pressure up via fluids + inotropic support (drugs to force the blood pressure up via working the heart or vasoconstriction of blood vessels). This most probably brought them the time required.

[Geodd]

First reaction. Man, that's fucking cool

Second reaction: Fucking Jehovah's Witnesses

Better headline: "Science saves moron's life, despite her and her families best efforts

The only bad thing that will come from this is that it will further the Jehovah's Witnesses quaint delusion that their retarded refusal of blood products is the main reason for development of blood alternatives.

[LaCroix]

Cool thing and a really impressive medical feat keeping her alive so long.
This product could be a big breakthrough in medicine. Blood donation is much to expensive on a long term to stay feasible.

One question - who else read the headline and immediately though "True Blood"?

[kc8tbe]

So first of all, hooray science. Synthetic blood could save a lot of lives down the road.

Secondly, wtf Jehovah's witness? You can't accept a blood transfusion, but you can use a product made from an animals blood? Cow plasma = acellular component of bovine blood.

[Broomstick]

Don't point that out, or they'll get stupid about that, too.

[PainRack]

So first of all, hooray science. Synthetic blood could save a lot of lives down the road.

Secondly, wtf Jehovah's witness? You can't accept a blood transfusion, but you can use a product made from an animals blood? Cow plasma = acellular component of bovine blood.

Actually, some Jehovah Witnesses already accept blood plasma type products. Just not the Red Blood Cells or platelets.

[Molyneux]

Yes, the Jehovah's Witnesses are fucking idiots, but damn, this is a great job by the medicos. They deserve plenty of kudos for this!

[Enigma]

So first of all, hooray science. Synthetic blood could save a lot of lives down the road.

Secondly, wtf Jehovah's witness? You can't accept a blood transfusion, but you can use a product made from an animals blood? Cow plasma = acellular component of bovine blood.

Actually, some Jehovah Witnesses already accept blood plasma type products. Just not the Red Blood Cells or platelets.

Now, before I read the article, I already knew this would involve a JW.

Transfusions using whole blood, red cells, white cells, platelets or plasma are a no no for JWs. But blood fractions and medical procedures involving use of the patient's blood is left up to the individual JW.

As regards to the article,

The synthetic contains a molecule derived from cow plasma and restored her levels of haemoglobin, which carries oxygen to the tissues.

They didn't use the plasma as a whole but a fraction in this case a molecule derived from cow plasma. It was well within her perogative to choose this synthetic blood.