Thenuwara K, Thomas J, Ibsen M, Ituk U, Choi K, Nickel E, Goodheart MJ, et al.
International journal of obstetric anesthesia. Date of publication 2017 Feb 1;volume 29():73-80.
1. Int J Obstet Anesth. 2017 Feb;29:73-80. doi: 10.1016/j.ijoa.2016.10.006. Epub
2016 Oct 24.
Use of hyperbaric oxygen therapy and PEGylated carboxyhemoglobin bovine in a
Jehovah's Witness with life-threatening anemia following postpartum hemorrhage.
Thenuwara K(1), Thomas J(2), Ibsen M(2), Ituk U(2), Choi K(3), Nickel E(4),
Goodheart MJ(5).
Author information:
(1)Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City,
IA, USA. Electronic address: Kokila-thenuwara@uiowa.edu.
(2)Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City,
IA, USA.
(3)Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City,
IA, USA.
(4)Departments of Pharmaceutical Care & Anesthesia, University of Iowa Hospitals
and Clinics, Iowa City, IA, USA.
(5)Department of Obstetrics and Gynecology, University of Iowa Hospitals and
Clinics, Iowa City, IA, USA.
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 12mg/dL to
3mg/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
7mg/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.
Copyright © 2016 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.ijoa.2016.10.006
PMID: 27890467 [Indexed for MEDLINE]
