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A synthetic haemoglobin-based oxygen carrier and the reversal of cardiac hypoxia secondary to severe anaemia following trauma

Mark C Fitzgerald, Julie Y Chan, Andrew W Ross, Susan M Liew, Warwick W Butt, David Baguley, Hatem H Salem, Matthias K Russ, Conor Deasy, Katherine E Martin, Joseph K Mathew and Jeffrey V Rosenfeld
Med J Aust 2011; 194 (9): 471-473.

We report a case of compassionate use of a haemoglobin-based oxygen carrier in a severely injured Jehovah’s Witness patient, for whom survival was considered unlikely. Severe anaemia and cardiac hypoxia were reversed after slow infusion of this agent. No vasoactive side effects were associated with the treatment, possibly due to the slow infusion, and the patient survived. (MJA 2011; 194: 471-473)

A healthy 32-year-old woman was a passenger in a vehicle involved in a high-speed collision with a truck, and she was entrapped for 2 hours. Initially, her heart rate was 100 beats/min, blood pressure was 90/50 mmHg, respiratory rate was 28 breaths/min and oxygen saturation measured by pulse oximetry (SpO2) was 92% on air. Her Glasgow Coma Scale score was 9 (eye opening, 2; verbal response, 1; motor response, 6) and her pupils were equal and reactive to light. Her family indicated that she was a Jehovah’s Witness and would not accept the units of blood that had been transported to the accident site. Paramedics performed endotracheal intubation, immobilisation, left femoral splinting and resuscitation with a 7000 mL crystalloid infusion, and applied dressings to wounds. The patient was transported by helicopter to The Alfred’s trauma centre.

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  • Mark C Fitzgerald1
  • Julie Y Chan1
  • Andrew W Ross1
  • Susan M Liew1
  • Warwick W Butt1
  • David Baguley1
  • Hatem H Salem1
  • Matthias K Russ1
  • Conor Deasy1,2
  • Katherine E Martin1
  • Joseph K Mathew1
  • Jeffrey V Rosenfeld2

  • 1 The Alfred, Melbourne, VIC.
  • 2 Monash University, Melbourne, VIC.


Acknowledgements: 

We thank Jeffrey Box (Senior Scientist, Clinical Biochemistry, Alfred Pathology Service) for advice and data related to potential effects of HBOC-201 on serum troponin I analysis.

Competing interests:

Mark Fitzgerald had travel and accommodation expenses covered by Biopure (the then manufacturer of HBOC-201) for attendance at a 2-day meeting in Boston in 2006 to provide independent commentary on a planned research project.

  • 1. Katz LM, Manning JE, McCurdy S, et al. Nitroglycerin attenuates vasoconstriction of HBOC-201 during hemorrhagic shock resuscitation. Resuscitation 2010; 81: 481-487.
  • 2. Evans JA, van Wessem KJ, McDougall D, et al. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 2010; 34: 158-163.
  • 3. Atkin C, Freedman I, Rosenfeld JV, et al. The evolution of an integrated State Trauma System in Victoria, Australia. Injury 2005; 36: 1277-1287.
  • 4. Weiskopf RB, Viele MK, Feiner J, et al. Human cardiovascular and metabolic response to acute, severe isovolemic anemia. JAMA 1998; 279: 217-221.
  • 5. Weiskopf RB. Emergency transfusion for acute severe anemia: a calculated risk. Anesth Analg 2010; 111: 1088-1092.
  • 6. Corporation B. Hemopure. Cambridge, Mass: Biopure Corporation, 2008. http://www.hemopure.co.za/downloads/HemopureSouthAfrica_PI.pdf (accessed Mar 2011).
  • 7. Marinaro J, Smith J, Tawil I, et al. HBOC-201 use in traumatic brain injury: case report and review of literature. Transfusion 2009; 49: 2054-2059.
  • 8. Mackenzie CF, Morrison C, Jaberi M, et al. Management of hemorrhagic shock when blood is not an option. J Clin Anesth 2008; 20: 538-541.
  • 9. Sarani B, Pryor J. Hemoglobin-based oxygen carriers as rescue therapy: justified experiment or unnecessary risk [editorial]? J Clin Anesth 2008; 20: 489-491.
  • 10. Natanson C, Kern SJ, Lurie P, et al. Cell-free hemoglobin-based blood substitutes and risk of myocardial infarction and death: a meta-analysis. JAMA 2008; 299: 2304-2312.
  • 11. Mackenzie CF, Moon-Massat PF, Shander A, et al. When blood is not an option: factors affecting survival after the use of a hemoglobin-based oxygen carrier in 54 patients with life-threatening anemia. Anesth Analg 2010; 110: 685-693.
  • 12. Mackenzie CF. Haemoglobin-based oxygen carriers: is the benefit worth the risk? Br J Hosp Med (Lond) 2009; 70: 26-30.
  • 13. Donahue LL, Shapira I, Shander A, et al. Management of acute anemia in a Jehovah’s Witness patient with acute lymphoblastic leukemia with polymerized bovine hemoglobin-based oxygen carrier: a case report and review of literature. Transfusion 2010; 50: 1561-1567.

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