Free Murder and Mayhem by D. P. Lyle Page B

for hepatitis and AIDS cannot be done quickly. Several hours and up to a day or two would be required. As the injured rolled in, it would be necessary for these considerations to take a backseat. After all, would you rather bleed to death or risk the very small possibility of contracting hepatitis or AIDS?
    At some point all this would not be enough, and unmatched (type specific) and untested blood would have to be used to save some lives. Type-specific blood is the same type that the patient has, but it does not have full cross-matching of all possible incompatibilities. It takes only a few minutes and very little equipment to determine if blood is O-negative, for example, but it is more involved to actually test the donor blood against that of the recipient for true compatibility. This increases the possibility of a reaction, but this situation exemplifies the old adage: "Any port in a storm."
    What Is Artificial Blood?
    Q: While on a safari in Africa, one of my characters is attacked and severely injured by a crocodile. His leg is mauled, and he nearly bleeds to death before he is evacuated to a hospital. I've read recently about artificial blood and may want to incorporate it in my story. What is artificial blood? Is it available? Are there any problems?
    A: Artificial blood has been the subject of research for three decades. The concerns regarding AIDS and hepatitis, the erratic availability and difficulty in storing and transporting real blood, and the need for blood in remote areas such as war zones has driven this research.
    First a word about what artificial blood is and isn't. It is a product that supplies molecules capable of carrying oxygen from the lungs to the tissues and bringing carbon dioxide back to the lungs to be expelled. The normal IV fluids given to patients in shock or those suffering from blood loss are basically water with some electrolytes (sodium, potassium, and so forth) and sugar, and they have no ability to carry oxygen, which is the immediate concern in shock situations. Artificial blood is designed to fill this need.
    However, artificial blood is not real blood. It does not contain vitamins, nutrients, hormones, antibodies, platelets (small blood cells involved in clotting), or any of the proteins involved in the clotting of blood. If given injudiciously or in large amounts, it will dilute these needed clotting factors and lead to a worsening of the bleeding, which would be counterproductive. Artificial blood is used as a bridge to stabilize the victim long enough to get him to a proper medical facility, where definitive treatment can be rendered and real blood given.
    Early attempts at developing artificial blood revolved around extracting the hemoglobin molecule and modifying it so that it could be given without giving the entire red blood cell (RBC), which must be stored and refrigerated. Hemoglobin is the molecule within the RBCs that binds, carries, and releases oxygen and carbon dioxide. Unfortunately, the hemoglobin molecule when removed from the RBCs is very toxic and causes an increase in mortality. A report in the November 17, 1999, issue of the Journal of the American Medical Association showed that such a product, called HemaAssist (Baxter Healthcare), when used in trauma patients led to a mortality rate of 46 percent as compared to a rate of only 17
    percent in those who received the typical IV fluids. It was back to the drawing board.
    Several other products are under development and being tested at this time. One of the most promising is called Hemopure, which is produced by the Biopure Corporation in Cambridge, Massachusetts. It was recently approved for use in South Africa but as yet is not available in the United States. Hemopure is based on hemoglobin extracted from the RBCs of cow blood. Unlike whole blood, it doesn't need to be refrigerated and has a shelf life of two years (42 days is usual for properly refrigerated blood). Its administration is simple: Start an IV and