Use of hyperbaric oxygen therapy and PEGylated carboxyhemoglobin bovine in a Jehovah's Witness with life-threatening anemia following postpartum hemorrhage

K. Thenuwara, Joss J Thomas, M. Ibsen, U. Ituk, K. Choi, E. Nickel, M. J. Goodheart

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

We present a case of a Jehovah's Witness patient who refused blood products, with the exception of albumin and clotting factors, and underwent cesarean section under spinal anesthesia complicated by postpartum hemorrhage. She was fluid resuscitated and treated with multiple uterotonics and internal iliac artery embolization. Because of agitation she required emergency tracheal intubation. Her hemoglobin concentration dropped from a preoperative value of 12 mg/dL to 3 mg/dL on postoperative day one. She was acidotic, requiring vasopressors for hemodynamic stability and remained ventilated and sedated. She was treated with daily erythropoietin, iron therapy and cyanocobalamin. Because of ongoing hemorrhage, continued acidemia and vasopressor requirements she was co-treated with PEGylated carboxyhemoglobin bovine and hyperbaric oxygen therapy to reverse her oxygen debt. On postoperative day eight her hemoglobin concentration was 7 mg/dL, she was hemodynamically stable and vasopressors were discontinued. She was extubated and discharged from the intensive care unit on postoperative day eight. This report highlights the multiple modalities used in treating a severely anemic patient who refused blood, the use of an investigational new drug, the process of obtaining this drug via the United States Food and Drug Administration emergency expanded access regulation for single patient clinical treatment, and ethical dilemmas faced during treatment.

Original languageEnglish (US)
Pages (from-to)73-80
Number of pages8
JournalInternational Journal of Obstetric Anesthesia
Volume29
DOIs
StatePublished - Feb 1 2017

Fingerprint

Jehovah's Witnesses
Carboxyhemoglobin
Postpartum Hemorrhage
Hyperbaric Oxygenation
Anemia
Hemoglobins
Emergencies
Investigational Drugs
Blood Coagulation Factors
Iliac Artery
Spinal Anesthesia
United States Food and Drug Administration
Vitamin B 12
Erythropoietin
Intubation
Cesarean Section
Intensive Care Units
Albumins
Therapeutics
Iron

Keywords

  • Hyperbaric oxygen therapy
  • Jehovah's Witness
  • PEGylated carboxyhemoglobin bovine

Cite this

Use of hyperbaric oxygen therapy and PEGylated carboxyhemoglobin bovine in a Jehovah's Witness with life-threatening anemia following postpartum hemorrhage. / Thenuwara, K.; Thomas, Joss J; Ibsen, M.; Ituk, U.; Choi, K.; Nickel, E.; Goodheart, M. J.

In: International Journal of Obstetric Anesthesia, Vol. 29, 01.02.2017, p. 73-80.

Research output: Contribution to journalArticle

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