Author/Authors :
Posluszny، Joseph A. نويسنده Department of Surgery, Division of Acute Care Surgery
(Trauma, Burns, Critical Care, Emergency Surgery), University of
Michigan, Ann Arbor, USA , , Napolitano، Lena M. نويسنده Department of Surgery, Division of Acute Care Surgery
(Trauma, Burns, Critical Care, Emergency Surgery), University of
Michigan, Ann Arbor, USA ,
Abstract :
Treatment of severe hemorrhagic shock due to acute blood loss from
traumatic injuries in a Jehovah’s witness (JW) trauma patient is very
challenging since hemostatic blood product resuscitation is limited by
refusal of the transfusion of allogeneic blood products. We describe a
multifaceted approach to the clinical care of a severely anemic JW
trauma patient including the early administration of a bovine
hemoglobin-based oxygen carrier (HBOC) as a bridge to resolution of
critical anemia (nadir hemoglobin 3.9 g/dL). Hemoglobin-based oxygen
carrier infusions were used to supplement oxygen delivery until
endogenous erythropoiesis could restore adequate red blood cell mass.
Subsequent endogenous bone marrow recovery was supported by early
administration of high-dose erythropoiesis-stimulating agents and iron
supplementation. Early HBOC administration can be used in the treatment
of severe hemorrhagic shock in trauma patients who refuse allogeneic
blood.
