Editing Blood transfusion (section)

== Research into alternatives ==
{{See also|Blood substitutes}}
Although there are clinical situations where transfusion with red blood cells is the only clinically appropriate option, clinicians look at whether alternatives are feasible. This can be due to several reasons, such as patient safety, economic burden or scarcity of blood. Guidelines recommend blood transfusions should be reserved for patients with or at risk of cardiovascular instability due to the degree of their anaemia.<ref>{{cite journal | vauthors = Goddard AF, James MW, McIntyre AS, Scott BB | title = Guidelines for the management of iron deficiency anaemia | journal = Gut | volume = 60 | issue = 10 | pages = 1309–16 | date = October 2011 | pmid = 21561874 | doi = 10.1136/gut.2010.228874 | doi-access = free | collaboration = British Society of Gastroenterology }}</ref><ref>{{cite journal | vauthors = Shander A, Fink A, Javidroozi M, Erhard J, Farmer SL, Corwin H, Goodnough LT, Hofmann A, Isbister J, Ozawa S, Spahn DR | display-authors = 6 | title = Appropriateness of allogeneic red blood cell transfusion: the international consensus conference on transfusion outcomes | journal = Transfusion Medicine Reviews | volume = 25 | issue = 3 | pages = 232–246.e53 | date = July 2011 | pmid = 21498040 | doi = 10.1016/j.tmrv.2011.02.001 | others = International Consensus Conference on Transfusion Outcomes Group }}</ref> In stable patients with iron deficiency anemia, oral or [[parenteral iron]] is recommended.

Thus far, there are no FDA-approved ''oxygen-carrying'' [[blood substitutes]], which is the typical objective of a blood (RBC) transfusion. Non-blood ''volume expanders'' are available for cases where only volume restoration is required, but a substance with oxygen-carrying capacity would help doctors and surgeons avoid the risks of disease transmission and immune suppression, address the chronic blood donor shortage, and address the concerns of [[Jehovah's Witnesses]] and others who have religious objections to receiving transfused blood.

The research in this area is ongoing. A number of blood substitutes have been explored, but thus far they all have serious limitations.<ref name="p925">{{cite journal | last=Standl | first=T. | title=Haemoglobin-based erythrocyte transfusion substitutes | journal=Expert Opinion on Biological Therapy | volume=1 | issue=5 | date=2001 | issn=1471-2598 | pmid=11728218 | doi=10.1517/14712598.1.5.831 | pages=831–843}}</ref><ref name="u615">{{cite journal | last1=Cao | first1=Min | last2=Zhao | first2=Yong | last3=He | first3=Hongli | last4=Yue | first4=Ruiming | last5=Pan | first5=Lingai | last6=Hu | first6=Huan | last7=Ren | first7=Yingjie | last8=Qin | first8=Qin | last9=Yi | first9=Xueliang | last10=Yin | first10=Tao | last11=Ma | first11=Lina | last12=Zhang | first12=Dingding | last13=Huang | first13=Xiaobo | title=New Applications of HBOC-201: A 25-Year Review of the Literature | journal=Frontiers in Medicine | volume=8 | date=2021 | pmid=34957164 | pmc=8692657 | doi=10.3389/fmed.2021.794561 | doi-access=free | page=794561}}</ref> Most attempts to find a suitable alternative to blood thus far have concentrated on cell-free hemoglobin solutions. Blood substitutes could make transfusions more readily available in [[emergency medicine]] and in pre-hospital [[Emergency medical service|EMS]] care. If successful, such a blood substitute could save many lives, particularly in trauma where massive blood loss results. [[Hemopure]], a hemoglobin-based therapy, is approved for use in [[South Africa]] and has been used in the United States on a case-by-case basis through the emergency Investigational New Drug (IND) process.<ref name="y203">{{cite journal | last1=Zumberg | first1=Marc | last2=Gorlin | first2=Jed | last3=Griffiths | first3=Elizabeth A. | last4=Schwartz | first4=Garry | last5=Fletcher | first5=Bradley S. | last6=Walsh | first6=Katherine | last7=Dao | first7=Kim-Hien | last8=Vansandt | first8=Amanda | last9=Lynn | first9=Mauricio | last10=Shander | first10=Aryeh | title=A case study of 10 patients administered HBOC-201 in high doses over a prolonged period: outcomes during severe anemia when transfusion is not an option | journal=Transfusion | volume=60 | issue=5 | date=2020 | issn=1537-2995 | pmid=32358832 | doi=10.1111/trf.15778 | pages=932–9}}</ref>