Abstract
Purpose
To describe the successful treatment of acute, life-threatening anemia with the oxygen therapeutic agent, hemoglobin (Hb) raffimer.
Clinical features
A 53-yr-old female Jehovah’s Witness developed severe anemia following total hip replacement. Due to prior patient directive, red blood cells were not transfused. Tachycardia, hypotension, electrocardiographic abnormalities and mental status changes developed with a nadir Hb concentration of 3.2 g.dL-1. Hb raffimer is a purified, cross-linked, human Hb solution developed as a substitute for red blood cell Hb. After obtaining informed consent as well as Food and Drug Administration and Institutional Review Board approval for compassionate use, 2 L of Hb raffimer (Hemolink, Hemosol, Inc., Toronto, ON, Canada) were administered along with ferrous sulfate and epoetin alfa therapy. The patient’s Hb level rose to 5.5 g.dL-1 with resolution of symptoms. To allow recovery of red blood cell mass while maintaining Hb level > 4.5 g.dL-1, additional 1000 mL doses of Hb raffimer were administered on postoperative days three, five and seven (total dose = 500 g Hb). The patient developed no serious adverse events related to treatment with Hb raffimer. By postoperative day 14, the patient’s Hb level increased to 6.5 g.dL-1 with a hematocrit of 23%. The patient was discharged.
Conclusions
Use of Hb raffimer as a bridge to recovery of this patient’s red blood cell mass may have prevented adverse clinical outcome. Because this product is a purified Hb solution devoid of other cellular components, it may be accepted as therapy by patients who, due to religious conviction, refuse allogeneic red blood cell transfusion.
Objectif
Décrire le traitement réussi d’une grave anémie aiguë avec un agent d’oxygénothérapie, un raffimère d’hémoglobine (Hb).
éléments cliniques
Une femme de 53 ans, témoin de Jéhovah, souffrait d’anémie sévère post-arthroplastie totale de la hanche. Elle refusait toute transfusion sanguine. De la tachycardie, de l’hypotension, des anomalies électrocardiographiques et des changements de l’état mental sont apparus avec une concentration d’Hb minimale de 3,2 g.dL-1. Le raffimère d’Hb est une solution d’Hb humaine purifiée, polymérisée, développée comme substitut de l’Hb des globules rouges. Avec l’approbation, pour usage humanitaire, de la patiente, de la Food and Drug Administration et du Comité d’examen de l’institution, 2 L de raffimère d’Hb (Hemolink, Hemosol, Inc., Toronto, ON, Canada) ont été administrés avec du sulfate ferreux et de l’érythropoïétine humaine. L’Hb s’est élevée à 5,5 g.dL-1 avec la résolution des symptômes. Pour assurer la récupération de la masse sanguine tout en maintenant le niveau d’Hb > 4,5 g.dL-1, des doses additionnelles de 1000 mL de raffimère d’Hb ont été donnés aux jours trois, cinq et sept postopératoires (dose totale = 500 g d’Hb). Aucune complication sérieuse liée au raffimère d’Hb ne s’est développée. Au jour postopératoire 14, le niveau d’Hb est monté à 6,5 g.dL-1 avec un hématocrite de 23 %. La patiente a reçu son congé.
Conclusion
Le raffimère d’Hb, utilisé pour favoriser la récupération de la masse sanguine peut avoir évité des complications cliniques. Cette solution d’Hb purifiée dépourvue d’autres composantes cellulaires peut constituer un traitement acceptable aux patients qui, par conviction religieuse, refusent une transfusion allogénique.
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Lanzinger, M.J., Hill, S.E., Niklason, L.E. et al. Use of hemoglobin raffimer for postoperative life-threatening anemia in a Jehovah’s Witness. Can J Anesth 52, 369–373 (2005). https://doi.org/10.1007/BF03016278
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DOI: https://doi.org/10.1007/BF03016278