Therapeutic whole blood exchange using plasma exchange kit on a cell separator in a patient with refractory methemoglobinemia

Bhasker, Bala; Aluri, Anamika; Ramakrishna,

doi:10.1016/j.transci.2020.102910

Cited by 3 publications

(6 citation statements)

References 2 publications

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“…If there is no improvement with the use of repeated dose of MB, therapeutic whole blood exchange (TWBE) or hyperbaric oxygen therapy should be considered 84–88 . In a systematic review, TWBE lead to a survival rate of 81.6% in patients refractory to MB 89,90 …”

Section: Introductionmentioning

confidence: 99%

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Recommendations for diagnosis and treatment of methemoglobinemia

et al. 2021

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Methemoglobinemia is a rare disorder associated with oxidization of divalent ferroiron of hemoglobin (Hb) to ferri-iron of methemoglobin (MetHb). Methemoglobinemia can result from either inherited or acquired processes. Acquired forms are the most common, mainly due to the exposure to substances that cause oxidation of the Hb both directly or indirectly. Inherited forms are due either to autosomal recessive

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Section: Introductionmentioning

confidence: 99%

“… 84 , 85 , 86 , 87 , 88 In a systematic review, TWBE lead to a survival rate of 81.6% in patients refractory to MB. 89 , 90 …”

Section: Introductionmentioning

confidence: 99%

Recommendations for diagnosis and treatment of methemoglobinemia

et al. 2021

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“…In a similar study, upon unavailability of methylene blue, the case received 3800 ml of therapeutic whole blood exchange as the emergency intervention. 14 The case improved significantly, and methemoglobin was diminished to 5.2%. 14 The systematic review paper also summarized the median value of the amount of blood exchanged as 3000 mL among 24 cases.…”

Section: Discussionmentioning

confidence: 92%

“…14 The case improved significantly, and methemoglobin was diminished to 5.2%. 14 The systematic review paper also summarized the median value of the amount of blood exchanged as 3000 mL among 24 cases. 14 The use of N-acetylcysteine to minimize the methemoglobinemia is not yet permitted to treat methemoglobinemia.…”

Section: Discussionmentioning

confidence: 92%

“…An editorial with similar setting mentioned the improvement in a case of 60 years old male with poor Glassgow coma scale after transfusion in three different cycles. 13,14 Another case in a different study indicated that a case with similar characteristics expired, giving contrasting outcome. 15 The improved in this study received 700 ml (II-pint) fresh blood and 1750 ml (V pint) whole blood transfusion exchange.…”

Section: Discussionmentioning

confidence: 99%

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Nitrobenzene Induced Methemoglobinemia with Paroxysmal Atrial Fibrillation Treated with Single Volume Exchange Transfusions

Sapkota¹,

Vaidhya²,

Bhatt³

et al. 2022

Kathmandu Univ. Med. J.

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Methemoglobinemia is a potentially fatal condition if left untreated. Conventional treatment of nitrobenzene induced methemoglobinemia dictates the use of methylene blue, which is the antidote of choice. However, its availability in our setting is limited only to the laboratory use. We present a case of a 21-year-old female with intentional ingestion of nitrobenzene. Clinical history and supportive investigations revealed methemoglobinemia and it was successfully managed with single volume exchange transfusions in absence of specific antidote. While exchange transfusions are indicated for severe cases, it may be useful as an alternative treatment in acute life-threatening conditions where methylene blue is not available.

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A Case Series of Acquired Methemoglobinemia Due to Pesticides: Conventional to Novel Therapies

Lakshmikanthcharan¹,

Nandakumar²,

Angamuthu³

2023

Indian Journal of Critical Care Case Report

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A 57-year-old gentleman with an alleged history of (h/o) consumption of approximately 50-100 mL of a pesticide (1:2 compound, containing bioemulsifier 6%; oligosaccharide, 8%; fillers/carriers, 86%) at his home presented within 2 hours to a private hospital where gastric lavage was done and referred for deteriorating conscious level. On arrival, 5 hours from the time of consumption, he was stuporous. Glasgow Coma Scale (GCS) was 7/15, had central cyanosis, SpO 2 -62% with severe hypotension, which responded to fluid. In view of poor GCS and low SpO 2 , he was ventilated. Post intubation SpO 2 -86% with 100% FiO 2 . His blood gas revealed normal saturations, and co-oximetry showed a methemoglobin level of 63.5%. In view of raised MetHb, he was administered 2 mg/kg of methylene blue and shifted to ICU. In the subsequent arterial blood gas, methemoglobin levels remained high. Further boluses of methylene blue were tried upto a cumulative dose of 7 mg/kg without consistent reduction of methemoglobin levels to normalcy. Glucose-6-phosphate dehydrogenase (G6PD) deficiency was ruled out. A hematologist consultation was obtained, and one cycle of plasmapheresis was attempted, but the level did not decrease. An exchange

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Therapeutic whole blood exchange using plasma exchange kit on a cell separator in a patient with refractory methemoglobinemia

Cited by 3 publications

References 2 publications

Recommendations for diagnosis and treatment of methemoglobinemia

Recommendations for diagnosis and treatment of methemoglobinemia

Nitrobenzene Induced Methemoglobinemia with Paroxysmal Atrial Fibrillation Treated with Single Volume Exchange Transfusions

A Case Series of Acquired Methemoglobinemia Due to Pesticides: Conventional to Novel Therapies

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