The 54-patient compassionate-use series
A multicenter study published in Anesthesia & Analgesia reviewed 54 patients with life-threatening anemia treated with available standard care plus HBOC-201 under compassionate-use conditions. The median hemoglobin concentration when HBOC-201 was requested was 4 g/dL.
Twenty-three patients, 41.8%, survived to hospital discharge. Earlier administration was associated with better survival than later administration, and the investigators reported that no serious adverse event in the series was attributed to HBOC-201.
The study population included consenting Jehovah’s Witnesses as well as other patients for whom blood was contraindicated or unavailable.
Published Jehovah’s Witness survival cases
Traumatic hemorrhagic shock
A 23-year-old Jehovah’s Witness trauma patient developed critical anemia with hemoglobin falling to 3.9 g/dL. HBOC-201 was provided through the FDA compassionate-use program as an oxygen-carrying bridge while endogenous erythropoiesis recovered. The patient later underwent pelvic fixation and was discharged home.
Acute leukemia and profound anemia
A 36-year-old Jehovah’s Witness with acute lymphoblastic leukemia developed symptomatic anemia with hemoglobin as low as 3.1 g/dL during induction chemotherapy. Hemopure was administered over 12 days. The published report states that the patient completed chemotherapy, was discharged in stable condition, and remained in remission at 28 months of follow-up reported in the paper.
Other emergency situations
The clinical literature includes additional HBOC-201 use in severe anemia associated with trauma, hemolysis, surgery, transplantation, sickle-cell complications and other situations in which conventional red-cell transfusion was unavailable or could not be used.
More recent U.S. Expanded Access experience
A 2025 report in the American Journal of Therapeutics described three patients for whom conventional blood products were not available and FDA Expanded Access was granted for HBOC-201. The authors characterized HBOC-201 resuscitation as potentially life-saving while other supportive, erythropoietic or immunomodulatory treatments took effect.
Why this history matters
The immediate clinical problem in these cases was not the need to reproduce every function of blood. It was the need to maintain oxygen-carrying capacity and tissue oxygen delivery during a period of profound anemia.
This is the historical clinical context in which the HBOC field becomes especially relevant: hemoglobin-based oxygen transport can act as a bridge while bleeding is controlled, the underlying disease is treated, and the patient’s own red-cell mass recovers.
BHOC perspective
BHOC — Biological Hemoglobin Oxygen Carrier — builds on the scientific field of HBOCs with the objective of advancing controlled hemoglobin-based oxygen transport and delivery as Precision Oxygen Therapeutics.
Clinical sources
Historical clinical evidence is presented to document prior HBOC use. It does not establish the safety or efficacy of BHOC, which is a separate technology under development.