117

community that has led to a sometimes destructive polar-

ization between those of us engaged in the development of
alternative oxygen transport formulations and those work-
ing on a daily basis to implement and improve the current
practice of transfusion. The reality is that even if alternative
oxygen carriers meet our wildest expectations, there will be
a need for traditional blood product collection, distribution,
and administration for the foreseeable future. On the other
hand, having alternatives with different risk/benet proles
than red cells, as well as logistical and/or immunologic
advantages, will undoubtedly improve the practice of medi-
cine. Having only one modality to treat the enormous range
of hypoxic and ischemic challenges facing patients is analo-
gous to having only one antibiotic to treat all infections, or
one chemotherapeutic to treat all cancers. Rather than defen-
sive argumentation, a more constructive approach would be
the establishment of a forthright and constructive dialogue
about the limitations and advantages of both current blood
transfusion practices and alternative oxygen carriers to es-
tablish the most efcient and co-operative way forward to
the improvement of patient care. This will require a num-
ber of outreach steps between those in the traditional blood
transfusion community and those attempting to develop al-
ternatives. One small, but not insignicant, step in this direc-
tion would be replacement of the label blood substitutes
with a more accurate and less provocative terminology.
Declaration of interest: The author is currently serving
as a consultant to Omniox, a biotechnology company
engaged in the development of a proprietary oxygen
delivery technology.
Letter to the Editor: What s in a Name?
Timothy N. Estep
Chart Biotech Consulting, LLC, Erie CO, USA
Over a half century of research and development with
alternative oxygen-transporting formulations has brought
substantial progress in understanding the potential and
challenges of these technologies but, as of yet, no com-
mercially successful products. Nonetheless, tantalizing
preclinical and clinical data suggest that such formula-
tions will ultimately prove clinically useful in a variety
of indications, such as the treatment of emergent red cell
loss and the oxygenation of ischemic and hypoxic tissues.
However, the variety of potential indications is likely to
require a comparable variety of formulations and active
principals engineered for specic applications. If one
thing has been learned in the preceding decades, it is that
one size denitely does not t all.
Perhaps even more important is that while oxygen car-
riers based on technologies such as heme proteins and per-
uorocarbon emulsions have many useful qualities, they
are denitely not blood substitutes. It is highly unlikely
that any single product can restore the oxygen transport,
coagulation factor, and immunological needs of patients
suffering extreme blood loss. While this has been recog-
nized and acknowledged for a number of years, the term
blood substitutes continues to be inappropriately applied.
Although grounded in a now prolonged historical usage,
the time has come to seriously consider a different nomen-
clature that more accurately portrays the advantages and
limitations of alternative oxygen transport technologies.
Such a change is more than semantic. In addition to
misrepresenting the eld of endeavor, the term blood sub-
stitutes has a strong and pejorative connotation to many re-
searchers and practitioners in the traditional blood banking
Address correspondence to Timothy N. Estep, Chart Biotech Consulting, LLC, Erie, CO 80516, USA. E-mail: chartbiotech@
comcast.net
Articial Cells, Blood Substitutes, and Biotechnology, 39: 117
Copyright 2011 Informa Healthcare USA, Inc.
ISSN: 1073-1199 print / 1532-4184 online
DOI: 10.3109/10731199.2010.502881
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