OtherArtificial oxygen carrierBlood substituteModified haemoglobin

Hemoglobin-Based Oxygen Carrier (HBOC)

Also known as HBOC · Hemopure · PolyHeme · HemAssist · Oxyglobin

Written by enwyReviewed 5 Aug 20262 sources0 comments

HBOCs are cell-free oxygen carriers made from chemically modified or cross-linked haemoglobin (human, bovine or recombinant), developed as blood substitutes. A landmark meta-analysis linked them to increased death and heart attack, ending most programmes. Their direct oxygen-carrying action makes them a doping concern; WADA prohibits artificial oxygen carriers.

01 Overview

Hemoglobin-based oxygen carriers use haemoglobin freed from red cells and stabilised (polymerised, cross-linked or encapsulated) so it can transport oxygen in plasma. Products such as HemAssist, Hemopure and PolyHeme were trialled for trauma and surgery. A 2008 meta-analysis (Natanson et al.) found a significant increase in myocardial infarction and death across HBOC trials, halting most development; a few products remain available in limited settings (e.g. Hemopure in South Africa).\n\nBecause cell-free haemoglobin scavenges nitric oxide, HBOCs cause vasoconstriction and hypertension, and are associated with cardiovascular events. In doping they are attractive for boosting oxygen transport but are prohibited by WADA and are dangerous without medical oversight.

02 Mechanism

Cell-free modified haemoglobin binds and releases oxygen in plasma like intracellular haemoglobin, but also scavenges nitric oxide, causing vasoconstriction; net effect is increased oxygen-carrying capacity with significant vascular side effects.

03 Dosing

Tier	Dose	Route	Notes
Trauma/surgery (trials)	30–60 g	IV	Product-specific unit dosing; no approved athletic use

04 Effects

Effect	Magnitude	Evidence
Increased oxygen-carrying capacityAdds cell-free oxygen transport to plasma, useful acutely when red cells are unavailable.	Plasma O2 transport	Clinical
Universal compatibility / no cross-matchingBeing cell-free, HBOCs need no blood-group matching and have a long shelf life, the original rationale as a trauma blood substitute.	No blood typing	Clinical

05 Side effects

Effect	Severity	Frequency	Evidence	Countermeasures
Myocardial infarction and deathPooled trial data showed increased risk of heart attack and mortality, which ended most HBOC development.	Life-threatening	Significant excess in meta-analysis	Clinical
Hypertension and vasoconstrictionCell-free haemoglobin raises blood pressure by scavenging nitric oxide.	Moderate	Common	Clinical

06 Legal status

United States

No FDA-approved product

WADA-prohibited as an artificial oxygen carrier; Hemopure available in limited jurisdictions · as of Jan 2026

07 References

Cell-free hemoglobin-based blood substitutes and risk of MI and death (meta-analysis)JAMA, 2008 (Natanson et al.)

WADA Prohibited List — S2 (artificial oxygen carriers)World Anti-Doping Agency

08 Discussion0 comments

Create account

Discussion is moderated. No sourcing, vendor names or price talk — those comments are removed, and repeat posts are banned.

This page is reference information, not medical advice. Doses and protocols are documented as they appear in the clinical literature and in practice — describing them is not a recommendation to use them. Countermeasures listed here are not a substitute for a physician. Legal status varies by jurisdiction and changes.