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1

Shamsul Bahrin, Safiah Syahirah, Siti Noor Fazliah Mohd Noor, Siti Salmah Noordin, Mohd Nadzri Mohd Najib, and Muhammad Azrul Zabidi. "CLASSIFICATION OF BLOOD SUBSTITUTES." Journal of Health and Translational Medicine sp2023, no. 1 (June 6, 2023): 261–77. http://dx.doi.org/10.22452/jummec.sp2023no1.28.

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Blood substitutes are substances used to replace or supplement the activities of biological blood cellular or acellular components. It is meant to be a transfusion-free option. There are four main categories that blood substitutes fall into: red blood cell substitutes, white blood cell substitutes, platelet substitutes, and plasma derivatives. Red blood cells (RBCs) substitutes can be divided into biological and chemical oxygen carriers. Biological oxygen carriers are haemoglobin-based oxygen carrier (HBOC) and stem cell derived red blood cells (cRBC). Sanguinate is the sole FDA-approved HBOC drug due to its sickle cell reversal, vasodilatory, and noninflammatory qualities while cRBC is utilized to produce universal group of RBCs. It has greater biological connections with natural bloods than chemical oxygen carriers, the second type of RBCs substitutes. When cRBC were transfused into participants, it was found that 63% of the cells continued to circulate in the blood, matching the half-life of a normal RBC, which is 28 days. These showed that red blood cells could be cultivated in a lab and that they also responded well in the human body. A study on stem cell derived red blood cells (cRBC) using growth stimulants, medium cultures, and genetic manipulation to immortalise human erythroid line has yielded mature RBCs. Now, this study is in the clinical trials which portrayed a huge success in the artificial blood field due to its immortal property. Perfluorocarbon (PFC) and polymer-based oxygen carriers are the two subcategories of chemical-based oxygen carriers. Products in this category may not be structurally resemble haemoglobin or RBCs, but they are intended to serve the primary physiological function of blood. Due to the complexity of the cellular parts of the immune system, no alternative to white blood cells (WBC) has been made artificially yet. However, immunotherapy strategies may offer the "functional substitution" for WBC especially in the case of artificial adaptive immunity. There have been approved alternatives for plasma derivatives but none to substitute platelets yet.
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2

Fromm, Robert E. "Blood substitutes." Critical Care Medicine 28, no. 6 (June 2000): 2150–51. http://dx.doi.org/10.1097/00003246-200006000-00091.

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3

Habib, Fahim A., and Stephen M. Cohn. "Blood substitutes." Current Opinion in Anaesthesiology 17, no. 2 (April 2004): 139–43. http://dx.doi.org/10.1097/00001503-200404000-00009.

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4

Palmer, Andre F., and Marcos Intaglietta. "Blood Substitutes." Annual Review of Biomedical Engineering 16, no. 1 (July 11, 2014): 77–101. http://dx.doi.org/10.1146/annurev-bioeng-071813-104950.

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5

Dietz, Niki M., Michael J. Joyner, and Mark A. Warner. "Blood Substitutes." Anesthesia & Analgesia 82, no. 2 (February 1996): 390–405. http://dx.doi.org/10.1097/00000539-199602000-00032.

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6

Mali, Shrikant Balasaheb. "Blood Substitutes." Journal of Craniofacial Surgery 26, no. 4 (June 2015): 1006–8. http://dx.doi.org/10.1097/scs.0000000000001611.

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7

Dietz, Niki M., Michael J. Joyner, and Mark A. Warner. "Blood Substitutes." Anesthesia & Analgesia 82, no. 2 (February 1996): 390–405. http://dx.doi.org/10.1213/00000539-199602000-00032.

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8

Winslow, Robert M. "Blood substitutes." Advanced Drug Delivery Reviews 40, no. 3 (February 2000): 131–42. http://dx.doi.org/10.1016/s0169-409x(99)00045-9.

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9

Cabrales, Pedro, and Marcos Intaglietta. "Blood Substitutes." ASAIO Journal 59, no. 4 (2013): 337–54. http://dx.doi.org/10.1097/mat.0b013e318291fbaa.

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10

Winslow, Robert M. "Blood substitutes." Current Opinion in Hematology 9, no. 2 (March 2002): 146–51. http://dx.doi.org/10.1097/00062752-200203000-00011.

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11

Dong, Qun, and Christopher P. Stowell. "Blood Substitutes." Pathology Patterns Reviews 118, suppl_1 (December 1, 2002): S71—S80. http://dx.doi.org/10.1309/6p2j-2b1k-gu0t-m5pr.

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12

R, Krishna Veni, Brindha Devi P, and Ivo Romauld S. "A REVIEW ON ARTIFICIAL BLOOD: A SOURCE WE NEED." Asian Journal of Pharmaceutical and Clinical Research 10, no. 9 (September 1, 2017): 38. http://dx.doi.org/10.22159/ajpcr.2017.v10i9.18960.

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Blood is a liquid tissue, in which abundant chemical factors and millions of different cells are dissolved. It is one of the most demanding sources in clinical and medical aspects. The issues and cost of human blood collection and storage directed this procedure toward the use of alternative blood. Thus, came an invention of artificial blood and blood substitutes. These alternative blood or blood substitute is a substance which is made to play as a substitute of erythrocytes. Thus, the main objective is to replace the normal human blood with artificial blood substitutes in the place of blood transfusion during surgeries and organ transfusion. Two major and focused blood substitutes in pharmaceutical aspects are perfluorocarbons and hemoglobin-based oxygen carriers (HBOC’s). Among these HBOCs vaguely resemble normal human blood. These blood substitutes are to allow flow through the blood stream to carry the oxygen and supply it to heart and other parts of the blood. They are used to fill the lost fluid volume. They are also called as plastic blood with iron atom as the base. They are found to serve as a good oxygen carrier. The results showed by these products are discussed, and they proved that they can act as a blood substitute and also they can reach the human tissue easier than erythrocytes and can control oxygen directly. However, these artificial blood products are being processed in research laboratories for good outcome. Their important functions are oxygen carrying capacity and to replace the lost blood volume in the human body. Their special features are survivability over a wider range of temperatures, eliminating cross matching, cost efficient, pathogen free, long shelf life, minimal side effects. Thus, artificial blood products are really a good alternative source which we need for replacing normal human blood.
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13

Vorobyev, Sergey Ivanovich, Viktor Pavlovich Kutyshenko, Sergey Brankovich Bolevich, Sergey Vladimirovich Votrin, Alexandra Sergeyevna Orlova, Stefani Bolevich, Elena Mihaylovna Morozova, and Maria Konstatinovna Kartashova. "Gas Transport Characteristics of Hemocorrectors and Perfusates Based on Perfluorocarbon Blood-Substituting Emulsions." Serbian Journal of Experimental and Clinical Research 21, no. 2 (June 1, 2020): 147–55. http://dx.doi.org/10.2478/sjecr-2020-0020.

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AbstractThis review summarizes the data regarding the gas transport characteristics of hemocorrection and perfusates on the basis of low concentrated drugs nano-sized perfluorocarbonic 20% Perftoran (a blood substitute, it is allowed for clinical use in Russia), 20% Ftoremulsion III (an improved blood substitute, registered in Russia), 10-20% Perfusol (a perfusion solution for perfusion of the isolated heart), 20% Ftorem (a cardioplegic emulsion for surgeries on the stopped heart) used in the biomedical field. The compensation of blood loss using traditional plasma substitutes without the gas transport function or with low gas transport characteristics leads to a decrease in the oxygen capacity of the resulting mixture and subsequently to deterioration in the oxygen transport characteristics of blood. The synthetic gas-transport blood substitutes can be used in the treatment of various forms of ischemia, such as carbon monoxide poisoning. Furthermore, recent results regarding the mechanism of COVID19 infection indicate a possible use of the synthetic gas-transport blood substitutes in the treatment and therapy of COVID19 infected patients.
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14

Lee, Sang-Yoon. "Application of DNA Containing Forensic Blood Substitute in the Bloodstain Pattern Analysis." Journal of Forensic, Legal & Investigative Sciences 7, no. 1 (June 2, 2021): 1–6. http://dx.doi.org/10.24966/flis-733x/100056.

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We were able to diversify blood substitutes that emphasized the existing physical characteristics by adding the synthetic DNA, which was designed and produced in this study, to developed blood substitute. By doing so, we could improve the availability of developed blood substitute to the point where it can be identified similarly as in DNA analysis from the human blood.
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15

Veeckman, Luc. "Artificial blood substitutes." Current Opinion in Anaesthesiology 10, no. 4 (August 1997): 280–83. http://dx.doi.org/10.1097/00001503-199708000-00009.

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16

Lowe, Kenneth C., and Clive Washington. "Alternative blood substitutes." Nature 358, no. 6389 (August 1992): 717–18. http://dx.doi.org/10.1038/358717b0.

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17

Biro, George P., Pierre Blais, and Arthur L. Rosen. "Perfluorocarbon blood substitutes." Critical Reviews in Oncology/Hematology 6, no. 4 (January 1987): 311–74. http://dx.doi.org/10.1016/s1040-8428(87)80018-5.

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18

Schneider, Philippe. "Artificial blood substitutes." Transfusion Science 13, no. 3 (July 1992): 357–70. http://dx.doi.org/10.1016/0955-3886(92)90148-a.

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19

Tappenden, J. "Artificial Blood Substitutes." Journal of the Royal Army Medical Corps 153, no. 1 (March 1, 2007): 3–9. http://dx.doi.org/10.1136/jramc-153-01-02.

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20

Lowe, Kenneth C. "Substitutes for blood." Expert Opinion on Pharmacotherapy 2, no. 7 (July 2001): 1057–59. http://dx.doi.org/10.1517/14656566.2.7.1057.

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21

INTAGLIETTA, MARCOS. "Editorial: Blood substitutes better than blood?" Transfusion Alternatives in Transfusion Medicine 9, no. 4 (December 2007): 199–203. http://dx.doi.org/10.1111/j.1778-428x.2008.00092.x.

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22

Ferguson, E., C. Prowse, E. Townsend, A. Spence, J. A. van Hilten, and K. Lowe. "Acceptability of blood and blood substitutes." Journal of Internal Medicine 263, no. 3 (March 2008): 244–55. http://dx.doi.org/10.1111/j.1365-2796.2007.01897.x.

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23

Ness, Paul M., and Melissa M. Cushing. "Oxygen Therapeutics: Pursuit of an Alternative to the Donor Red Blood Cell." Archives of Pathology & Laboratory Medicine 131, no. 5 (May 1, 2007): 734–41. http://dx.doi.org/10.5858/2007-131-734-otpoaa.

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Abstract Context.—There is no true substitute for the many functions of human red blood cells, and synthetic products will not replace the need for blood donation in the foreseeable future. Hemoglobin-based oxygen carriers have many characteristics that would serve as a useful adjunct to red cells in clinical settings. Over time, these technologies have the potential to dramatically reshape the practice of transfusion medicine. Objective.—To review the characteristics and potential utility of hemoglobin-based oxygen carriers and perfluorocarbon-based oxygen carriers. Several hemoglobin-based oxygen carriers are under study in phase III clinical trials. Novel uses for synthetic oxygen therapeutics are emphasized. Data Sources.—All published reports with the key words oxygen therapeutics, blood substitutes, and red cell substitutes from 1933 until March 2006 were searched through Medline. Significant findings were synthesized. Conclusions.—Recognition of the true impact of red cell substitutes is still several years away. The most compelling products, hemoglobin-based oxygen carriers, have potential use in trauma, providing immediate oxygen-carrying support in the face of alloantibodies or autoantibodies, and in other clinical situations in which long-term survival of red cells is not essential. In the interim, efforts should be focused on enhancing the current blood supply system while supporting ongoing and planned blood substitute research efforts, including trials assessing novel clinical indications for these products.
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24

Chang, Thomas Ming Swi. "Blood Substitutes in 2010 []." Artificial Cells, Blood Substitutes, and Biotechnology 38, no. 6 (November 12, 2010): 295–96. http://dx.doi.org/10.3109/10731199.2010.525808.

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25

Intaglietta, M. "Hemodilution and Blood Substitutes." Artificial Cells, Blood Substitutes, and Biotechnology 22, no. 2 (January 1994): 137–44. http://dx.doi.org/10.3109/10731199409117409.

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26

Cerny, L. C., E. L. Cerny, C. L. Cerny, M. Reath, M. Liszczynskyj, and S. Gabel. "Some potential blood substitutes." Clinical Hemorheology and Microcirculation 8, no. 5 (June 12, 2018): 621–36. http://dx.doi.org/10.3233/ch-1988-8509.

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27

Saini, Rajiv, Santosh Saini, and Sugandha Sharma. "Nanobiotechnology and blood substitutes." Asian Journal of Transfusion Science 5, no. 1 (2011): 56. http://dx.doi.org/10.4103/0973-6247.76004.

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28

Hodgson, John. "Substitutes For Human Blood." Nature Biotechnology 9, no. 8 (August 1991): 696. http://dx.doi.org/10.1038/nbt0891-696.

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29

Winslow, Robert M. "Progress on blood substitutes." Nature Medicine 3, no. 5 (May 1997): 474. http://dx.doi.org/10.1038/nm0597-474b.

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30

Otto, B. R., A. M. J. J. Verweij-van Vught, and D. M. MacLaren. "Blood substitutes and infection." Nature 358, no. 6381 (July 1992): 23–24. http://dx.doi.org/10.1038/358023b0.

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31

Winslow, Robert M., Kim D. Vandegriff, Armando Gonzales, Heinz Kerger, Amy G. Tsai, and Marcos Intaglietta. "NEWLY DEVELOPED BLOOD SUBSTITUTES." Shock 4, Supplement (December 1995): 13. http://dx.doi.org/10.1097/00024382-199512001-00053.

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32

Cohn, Stephen M. "Blood substitutes in surgery." Surgery 127, no. 6 (June 2000): 599–602. http://dx.doi.org/10.1067/msy.2000.106462.

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33

Alayash, Abdu I. "BLOOD SUBSTITUTES AND OXIDANTS." ASAIO Journal 49, no. 2 (March 2003): 220. http://dx.doi.org/10.1097/00002480-200303000-00316.

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34

Schwarz, Karl W., Scott A. Dulchavsky, and Allen Silbergleit. "Blood substitutes: an update." Current Surgery 59, no. 4 (July 2002): 378–83. http://dx.doi.org/10.1016/s0149-7944(01)00573-6.

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35

Waxman, Kenneth. "Perfluorocarbons as blood substitutes." Annals of Emergency Medicine 15, no. 12 (December 1986): 1423–24. http://dx.doi.org/10.1016/s0196-0644(86)80933-7.

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36

Chang, Thomas Ming Swi. "Red blood cell substitutes." Seminars in Anesthesia, Perioperative Medicine and Pain 17, no. 3 (September 1998): 208–15. http://dx.doi.org/10.1016/s0277-0326(98)80019-6.

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37

Drummond, G. B. "Red blood cell substitutes." British Journal of Anaesthesia 75, no. 4 (October 1995): 504–5. http://dx.doi.org/10.1093/bja/75.4.504-a.

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38

Tellez, M. Geno. "RED BLOOD CELL SUBSTITUTES." Shock 9, no. 3 (March 1998): 234. http://dx.doi.org/10.1097/00024382-199803000-00017.

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39

Chang, Thomas Ming Swi. "RED BLOOD CELL SUBSTITUTES*." Artificial Cells, Blood Substitutes, and Biotechnology 30, no. 5-6 (January 2002): 421–37. http://dx.doi.org/10.1081/bio-120016525.

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40

Waschke, K. F., M. Quintet, H. Kerger, and C. Lenz. "Oxygen-Carrying Blood Substitutes." Transfusion Medicine and Hemotherapy 24, no. 2 (1997): 114–20. http://dx.doi.org/10.1159/000223477.

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41

Winslow, RM. "Blood substitutes. Current status." Transfusion 29, no. 9 (November 1989): 753–54. http://dx.doi.org/10.1046/j.1537-2995.1989.29990070175.x.

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42

Chang, Thomas Ming Swi. "Red blood cell substitutes." Best Practice & Research Clinical Haematology 13, no. 4 (December 2000): 651–67. http://dx.doi.org/10.1053/beha.2000.0105.

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43

Gutteridge, Gary. "Crystalloids, colloids, blood, blood products and blood substitutes." Anaesthesia & Intensive Care Medicine 5, no. 2 (February 2004): 42–46. http://dx.doi.org/10.1383/anes.5.2.42.28695.

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44

Low, Daniel, and Michael Milne. "Crystalloids, colloids, blood, blood products and blood substitutes." Anaesthesia & Intensive Care Medicine 8, no. 2 (February 2007): 56–59. http://dx.doi.org/10.1016/j.mpaic.2006.12.006.

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45

Booth, Chris, and David Highley. "Crystalloids, colloids, blood, blood products and blood substitutes." Anaesthesia & Intensive Care Medicine 11, no. 2 (February 2010): 50–55. http://dx.doi.org/10.1016/j.mpaic.2009.12.002.

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46

Buckley, Hugo, and Roop Kishen. "Crystalloids, colloids, blood, blood products and blood substitutes." Anaesthesia & Intensive Care Medicine 14, no. 6 (June 2013): 255–60. http://dx.doi.org/10.1016/j.mpaic.2013.03.003.

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47

Rani, K. G. Aghila, Ahmed M. Al-Rawi, Ali Al Qabbani, Sausan AlKawas, Mohammad G. Mohammad, and A. R. Samsudin. "Response of human peripheral blood monocyte-derived macrophages (PBMM) to demineralized and decellularized bovine bone graft substitutes." PLOS ONE 19, no. 4 (April 18, 2024): e0300331. http://dx.doi.org/10.1371/journal.pone.0300331.

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The performance of apparently biocompatible implanted bovine bone grafts may be compromised by unresolved chronic inflammation, and poor graft incorporation leading to implant failure. Monitoring the intensity and duration of the inflammatory response caused by implanted bone grafts is crucial. In this study, the ability of demineralized (DMB) and decellularized (DCC) bovine bone substitutes in initiating inflammatory responses to peripheral blood monocyte-derived macrophages (PBMMs) was investigated. The response of PBMMs to bone substitutes was evaluated by using both direct and indirect cell culture, reactive oxygen species (ROS) generation, apoptosis, immunophenotyping, and cytokine production. Analysis of DMB and DCC substitutes using scanning electron microscope (SEM) showed a roughened surface with a size ranging between 500 and 750 μm. PBMMs treated with DMB demonstrated cell aggregation and clumping mimicking lipopolysaccharide (LPS) treated PBMMs and a higher proliferation ability (166.93%) compared to control (100%) and DCC treatments (115.64%; p<0.001) at 24h. This was associated with a significantly increased production of intracellular ROS in PBMMs exposed to DMB substitutes than control (3158.5 vs 1715.5; p<0.001) and DCC treatment (2117.5). The bone substitute exposure also caused an increase in percentage apoptosis which was significantly (p<0.0001) higher in both DMB (27.85) and DCC (29.2) treatment than control (19.383). A significant increase in proinflammatory cytokine expression (TNF-α: 3.4 folds; p<0.05) was observed in DMB substitute-treated PBMMs compared to control. Notably, IL-1β mRNA was significantly higher in DMB (21.75 folds; p<0.0001) than control and DCC (5.01 folds). In contrast, DCC substitutes exhibited immunoregulatory effects on PBMMs, as indicated by the expression for CD86, CD206, and HLDR surface markers mimicking IL-4 treatments. In conclusion, DMB excites a higher immunological response compared to DCC suggesting decellularization process of tissues dampen down inflammatory reactions when exposed to PBMM.
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48

Naisbitt, Christopher, Hugo Buckley, and Roop Kishen. "Crystalloids, colloids, blood products, and blood substitutes." Anaesthesia & Intensive Care Medicine 17, no. 6 (June 2016): 308–14. http://dx.doi.org/10.1016/j.mpaic.2016.03.005.

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49

Naisbitt, Christopher, K. F. A. Mos, and Roop Kishen. "Crystalloids, colloids, blood products and blood substitutes." Anaesthesia & Intensive Care Medicine 20, no. 6 (June 2019): 353–60. http://dx.doi.org/10.1016/j.mpaic.2019.03.007.

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50

Greer, Raquel C., Matti Marklund, Cheryl A. M. Anderson, Laura K. Cobb, Arlene T. Dalcin, Megan Henry, and Lawrence J. Appel. "Potassium-Enriched Salt Substitutes as a Means to Lower Blood Pressure." Hypertension 75, no. 2 (February 2020): 266–74. http://dx.doi.org/10.1161/hypertensionaha.119.13241.

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Use of salt substitutes containing potassium chloride is a potential strategy to reduce sodium intake, increase potassium intake, and thereby lower blood pressure and prevent the adverse consequences of high blood pressure. In this review, we describe the rationale for using potassium-enriched salt substitutes, summarize current evidence on the benefits and risks of potassium-enriched salt substitutes and discuss the implications of using potassium-enriched salt substitutes as a strategy to lower blood pressure. A benefit of salt substitutes that contain potassium chloride is the expected reduction in dietary sodium intake at the population level because of reformulation of manufactured foods or replacement of sodium chloride added to food during home cooking or at the dining table. There is empirical evidence that replacement of sodium chloride with potassium-enriched salt substitutes lowers systolic and diastolic blood pressure (average net Δ [95% CI] in mm Hg: –5.58 [–7.08 to –4.09] and –2.88 [–3.93 to –1.83], respectively). The risks of potassium-enriched salt substitutes include a possible increased risk of hyperkalemia and its principal adverse consequences: arrhythmias and sudden cardiac death, especially in people with conditions that impair potassium excretion such as chronic kidney disease. There is insufficient evidence regarding the effects of potassium-enriched salt substitutes on the occurrence of hyperkalemia. There is a need for additional empirical research on the effect of increasing dietary potassium and potassium-enriched salt substitutes on serum potassium levels and the risk of hyperkalemia, as well as for robust estimation of the population-wide impact of replacing sodium chloride with potassium-enriched salt substitutes.
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