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Fri Mar 21 16:20:09 GMT 2008

Hi ross

thanks so much, a great help as always.

 will never forget the day u helped me wrestle the psychotic dude

kind regards and hope that u enjoying antartica
> Hello Sa'ad my old friend ;)
>
> I gather by your mail that you attacked the primaries - well done!
>
> The real experts on the chitsoan products are the military crowd, with
> battlefield dressings and haemostatics being the predominant use.  I
> haven't
> seen it in SA, or heard of civilian use, although I am willing to be
> corrected.  (The only haemostatic I've seen in SA is TraumaDex, which uses
> tranexamic acid).  Chitosan is a linear polysaccharide derived from the
> exoskeleton of crustaceans (esp. shrimp) that contributes to very rapid
> clotting of blood via an ionic reaction between the positively-charged
> chitosan granules and negatively charged RBC's.
>
> I'm afraid I don't have any archived articles, but there was porcine
> research in J. Trauma in 2003 that showed a dramatic reduction in blood
> loss
> using a chitosan impregnated bandage compared to gauze(Pusateri, A. E., S.
> J. McCarthy, K. W. Gregory, R. A. Harris, L. Cardenas, A. T. McManus & C.
> W.
> Goodwin Jr. (2003). Effect of a chitosan-based hemostatic dressing on
> blood
> loss and survival in a model of severe venous hemorrhage and hepatic
> injury
> in swine. Journal of Trauma 4 (1): 177-182) - perhaps some-one on the list
> can cough it up.
>
> Bovine haemoglobin is the substrate used in the haemoglobin based oxygen
> carriers (HBOC's) - the one you may have heard of in SA is Hemopure.  The
> principle of an HBOC is precisely the oxygen bridge you mention - in acute
> anaemia or traumatic blood loss where blood is not available, one can
> administer an HBOC which raises the plasma haemoglobin (it's an acellular
> solution) to the point where O2 carrying capacity is life-sustaining.  The
> products have a limited half-life, but can be administered until blood
> products become available, or the acute crisis has passed.  There are some
> other benefits that are being investigated - the fact that the Hb is in
> the
> plasma rather than cells means that it can theoretically pass through
> smaller or partially occluded vessels, thus preserving ischaemic tissue
> that
> would otherwise have infacted.  There is research being done in CT
> surgery,
> and people are looking at it for management of certain types of wounds,
> including frostbite.  Another advantage (disclaimer: depending on your
> school of thought) is that the HBOC's are a hypertonic solution, allowing
> hypertonic, small-volume resus in haemorrhaging patients.  Other upsides
> include small physical volume, 3 year shelf-life, and no special storage
> requirements.  The downsides?  Well, it's not blood - it does nothing for
> clotting.  Too rapid administration can result in a spike in BP.  There
> have
> been reports of renal failure (seems to be predominantly with the older
> HBOC's).  Costly.  (Is that worth 8 marks?)
>
> I have some articles that I gathered while I was pushing for a supply of
> HBOC here in Antarctica and aboard the ship that I can forward should you
> wish.
>
> Will be holding thumbs for you when the results are out!
>
> Regards,
> Ross.
>
> Dr Ross Hofmeyr
> Expedition Leader  & Doctor
> South African National Antarctic Expedition
> ross.hofmeyr at sanane.sanap.ac.za
> wildmedic at gmail.com
> ross at wildmedix.com
> www.wildmedix.com
> Tel: +2721 405 9428
> Skype:  wildmedic
> “Semper Paratus”
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org [mailto:trauma-list-
>> bounces at trauma.org] On Behalf Of Sa'ad Lahri
>> Sent: 21 March 2008 07:19 AM
>> To: trauma-list at trauma.org
>> Subject: Alternative blood products
>>
>> Hi all
>>
>> Got asked the following two questions in our Emergency Medicine basic
>> sciences exam. Could you help with either resources or a short
>> explanation
>> and your current experience.
>>
>> 1.write short notes on chitosan products as adjuncts to haemorrhage
>> control including their mechanism of action (7 marks)
>>
>> 2.discuss the role of bovine haemoglobin as an oxygen bridge where blood
>> products are not available (8 marks)
>>
>> I have no experience using either of these products
>>
>> kind regards
>> Sa'ad
>>
>>
>> Dr Sa'ad Lahri
>> Emergency Medicine Registrar
>> UCT/US
>> Cape Town
>> South Africa
>>
>>
>>
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Dr Sa'ad Lahri
Emergency Medicine Registrar
UCT/US
Cape Town
South Africa
Tel: +27826642421

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