Use of hemoglobin raffimer for postoperative life-threatening anemia in a Jehovah's Witness

Marcella J. Lanzinger, Laura E. Niklason, Michael Shannon, Steven E. Hill

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)369-373
Number of pages5
JournalCanadian Journal of Anesthesia
Volume52
Issue number4
StatePublished - Apr 2005

Fingerprint

Jehovah's Witnesses
Anemia
Hemoglobins
Erythrocytes
Erythrocyte Volume
ferrous sulfate
Epoetin Alfa
Compassionate Use Trials
Therapeutics
Erythrocyte Transfusion
Hip Replacement Arthroplasties
O-raffinose cross-linked human hemoglobin
Research Ethics Committees
United States Food and Drug Administration
Informed Consent
Hematocrit
Tachycardia
Hypotension
Canada
Oxygen

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Use of hemoglobin raffimer for postoperative life-threatening anemia in a Jehovah's Witness. / Lanzinger, Marcella J.; Niklason, Laura E.; Shannon, Michael; Hill, Steven E.

In: Canadian Journal of Anesthesia, Vol. 52, No. 4, 04.2005, p. 369-373.

Research output: Contribution to journalArticle

Lanzinger, Marcella J. ; Niklason, Laura E. ; Shannon, Michael ; Hill, Steven E. / Use of hemoglobin raffimer for postoperative life-threatening anemia in a Jehovah's Witness. In: Canadian Journal of Anesthesia. 2005 ; Vol. 52, No. 4. pp. 369-373.
@article{159bbc9ae79745dcae9b4b4314545104,
title = "Use of hemoglobin raffimer for postoperative life-threatening anemia in a Jehovah's Witness",
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.",
author = "Lanzinger, {Marcella J.} and Niklason, {Laura E.} and Michael Shannon and Hill, {Steven E.}",
year = "2005",
month = "4",
language = "English (US)",
volume = "52",
pages = "369--373",
journal = "Canadian Journal of Anesthesia",
issn = "0832-610X",
publisher = "Springer New York",
number = "4",

}

TY - JOUR

T1 - Use of hemoglobin raffimer for postoperative life-threatening anemia in a Jehovah's Witness

AU - Lanzinger, Marcella J.

AU - Niklason, Laura E.

AU - Shannon, Michael

AU - Hill, Steven E.

PY - 2005/4

Y1 - 2005/4

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=19944370842&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=19944370842&partnerID=8YFLogxK

M3 - Article

C2 - 15814750

AN - SCOPUS:19944370842

VL - 52

SP - 369

EP - 373

JO - Canadian Journal of Anesthesia

JF - Canadian Journal of Anesthesia

SN - 0832-610X

IS - 4

ER -