Exceptional Blood-Loss Anemia
Am J Emerg Med. 2013 Apr;31(4):756.e3-4. doi: 10.1016/j.ajem.2012.11.013. Epub 2013 Feb 4.
Severe blood loss anemia in a Jehovah’s Witness treated with adjunctive hyperbaric oxygen therapy.
We describe the case of a 39-year-old African-American woman who developed sudden onset, near-term placental abruption with severe blood loss anemia whose religious beliefs precluded her from receiving any blood products. The patient had lost most of her blood volume, with a reported hemoglobin level of 1.9 g/dL, developed multisystem failure, and disseminated intravascular coagulation with bilateral deep venous thrombosis. Adjunctive hyperbaric oxygenation (HBO) therapy was considered, and the patient was referred for treatment. The patient required ventilatory support as well as vasopressors and hemodialysis. HBO therapy occured in a monoplace chamber setting at 2.0 atmospheres absolute for 90 minutes per treatment up to twice daily depending on patients clinical status. The patient underwent a total of 30 HBO treatments and had sustained improvement in all hemodynamic parameters, red blood cell volume, renal and respiratory function. She was discharged to a rehabilitation facility on hospital day 29 and then to home, soon thereafter. The patient had no evidence of sustained physical or cognitive impairment at time of discharge, and there were no reported complications associated with HBO therapy. Adjunctive HBO therapy should be considered in the management of patients with exceptional severe blood loss anemia who refuse the use of blood products.