The ‘normobaric oxygen paradox’: a simple way to induce endogenous erythropoietin production and concomitantly raise hemoglobin levels in anemic patients

Dear Sir, There is increasing concern regarding the inherent hazard of blood transfusions, host–graft reactions and transfusion-related acute lung injury. Considering the increasing population age, the increased need for blood products when reaching older age, and an already chronic shortage of blood products today, the need for alternative techniques to blood transfusion, and for new blood substitutes or blood salvage techniques is becoming more and more pressing. The use of blood cell progenitor enhancers like exogenous erythropoietin (EPO) is extensively recognized, and in patients with appropriate medical followup, a relatively low rate of adverse effects has been reported. However, the price of such medications is very high and in some countries, their availability is limited. A recently described phenomenon called the ‘normobaric oxygen paradox’ (NOP) may have clinical applications. The technique consists in a simple administration of high oxygen concentration to spontaneously breathing subjects. This has been shown to trigger a Transfusion Alternatives in Transfusion Medicine TATM