Liver function and morphology after resuscitation from severe hemorrhagic shock with hemoglobin solutions or autologous blood

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Abstract
To test the effects of three hemoglobin solutions on liver function and hepatic morphology after resuscitation from severe hemorrhagic shock. Prospective study. Laboratory. Thirty-three beagle dogs. Hemorrhagic shock was induced in anesthetized dogs by removal of blood at a rate of 2 mL/kg/min until systolic blood pressure (BP) reached 50 mm Hg. BP was maintained at this level for 2 hrs by further withdrawing 5 to 10 mL aliquots whenever BP increased more than 50 mm Hg. Resuscitation was then initiated with autologous whole blood (n equals 7), 4% pyridoxalated-hemoglobin-polyoxyethylene conjugate (4% PHP [n equals 6]), 8% pyridoxalated-hemoglobin-polyoxyethylene conjugate (8% PHP [n equals 9]), or 8% stroma-free hemoglobin (n equals 7). Four dogs were managed identically but were not resuscitated. Gross necropsy and histologic examination of the liver were performed on all dogs after 7 days, or earlier if death occurred. In vitro interferences of PHP and stroma-free hemoglobin with liver function tests were determined and recommendations for interpretation of results from blood samples containing PHP and stroma-free hemoglobin were made. Blood was collected before, during, and after resuscitation from hemorrhagic shock. The dogs were then awakened and survivors were monitored daily with blood sampling until they were killed and necropsy was performed. Morphologic studies at necropsy and liver function tests in dogs receiving hemoglobin solutions, compared with autologous blood, support the conclusion that the PHP and stroma-free hemoglobin solutions tested did not produce hepatic toxicity when used as resuscitation fluids in this model of severe shock.