(from Transfusion News)

HBOC-201 is a red cell substitute, modified cell-free haemoglobin. It is derived from bovine haemoglobin that has been extensively purified. It is licensed for use in South Africa, most recently since 2010. It is not licensed in the U.S. and can only be obtained there through emergency investigational new drug release (eIND).

The drug should be used only as an alternative to blood when it is unavailable, contraindicated, or refused by the patient. As the haemoglobin is cell-free, the drug does not need to be cross-matched with the recipient, as there are no red cell antigens present. The HBOC-201 hemoglobin oxygen dissociation curve is right-shifted compared to corpuscular haemoglobin. Fifty per cent of HBOC-201 oxygen binding sites become saturated at an oxygen pressure of 40 mmHg, compared to normal human haemoglobin at 27 mmHg. This lower affinity for oxygen allows HBOC-201 to release more oxygen in the peripheral tissues.

If administered, the drug has a short half-life of 19 hours, resulting in modest increases in plasma haemoglobin. It is also an isosmotic colloid solution, meaning that patients need to be monitored for evidence of fluid overload, and particularly those at greater risk (elderly, those with cardiovascular co-morbidities). Interestingly, patients can develop skin and scleral discoloration due to the metabolism of the plasma haemoglobin, which has been interpreted as jaundice (Mer, Hodgson et al. 2016).

References:

http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/InvestigationalNewDrugINDApplication/default.htm

Mer, M., E. Hodgson, et al. (2016). "Hemoglobin glutamer-250 (bovine) in South Africa: consensus usage guidelines from clinician experts who have treated patients." Transfusion 56(10): 2631-2636.

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