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Stroma-free acellular hemoglobin (SFH) is a first-generation hemoglobin-based oxygen carrier (HBOC) produced by lysing red blood cells and removing the stromal membranes. It was developed as a blood substitute to improve oxygen delivery to tissues without the need for cross-matching. However, SFH is chemically unstable in the bloodstream, dissociating from its natural tetrameric form into dimers that are rapidly cleared by the kidneys, causing nephrotoxicity. Additionally, it scavenges nitric oxide (NO) from the vascular endothelium, leading to potent vasoconstriction and systemic hypertension. Due to these significant adverse effects, SFH is no longer pursued as a therapeutic but serves as a critical negative control in the development of next-generation HBOCs, such as polymerized or encapsulated hemoglobins.
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