Management of life threatening post-partum hemorrhage with HBOC-201 in a Jehovah’s witness

Abstract

Background: Post-partum hemorrhage remains the leading cause of maternal mortality worldwide. The obstetrician and critical care physician should be aware of local alternative treatment options for symptomatic anemia secondary to postpartum hemorrhage in patients who cannot receive red blood cell transfusion. Transfusion may not be an option due to strong personal belief, lack of compatible blood, or blood shortage. Case: A 21-year-old woman, gravida 1 para 1001, was transferred to a tertiary care center for management of severe post-partum hemorrhage (hemoglobin 4.2 g/dL). She had undergone emergent dilation and curettage followed by Bakri tamponade balloon placement at an outside facility. As a member of the Jehovah's Witness faith, she refused red blood cell transfusion. HBOC-201, a bovine hemoglobin based oxygen carrier, was successfully used to reverse symptomatic, life-threatening anemia. Conclusion: HBOC-201 can act as a means to reverse severe end-organ damage for patients with severe post-partum hemorrhage and should be considered when no other treatment options are available.

When blood is not an option: Optimal bloodless management of severe anemia in pregnancy

“…Hemoglobin-based oxygen carriers have been successfully used in peripartum hemorrhage. 8 Additionally, sedation and ventilator support have been reported as an alternative strategy to decrease oxygen consumption in the case of severe anemia in a critically ill patient who declines blood transfusion. 9 Though this option was not pursued in this case, it could be considered in similar clinical scenarios.…”

“…A planned clinical study sponsored by the US Department of Defense will evaluate the use of Hemopure for treating trauma patients with hemorrhagic shock in the pre‐hospital setting in South Africa ( n = 1400 over 3 years). Hemoglobin‐based oxygen carriers have been successfully used in peripartum hemorrhage 8 . Additionally, sedation and ventilator support have been reported as an alternative strategy to decrease oxygen consumption in the case of severe anemia in a critically ill patient who declines blood transfusion 9 .…”