Hyperbaric oxygen should not be used in the management of hemorrhagic cystitis in patients with Fanconi anemia

Abstract

Hemorrhagic cystitis (HC) is a common complication after stem cell transplantation (SCT) that occurs more frequently in patients with Fanconi anemia (FA) because of hypersensitivity of their cells to the agents used in the preparation for SCT (chemo and radiation). Many HC cases respond to therapy with hyperhydration and maintenance of adequate platelet counts, but refractory cases may require additional measures such as the use of prostaglandins, alum, or hyperbaric oxygen (HBO). We report here an unusual complication to HBO therapy in a FA patient consisting of generalized edema mimicking capillary leak syndrome but with no pulmonary edema or ascites.

Clinical effectiveness of hyperbaric oxygen therapy for BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation

“…Fanconi anemia (FA) has been described as a relative contraindication for HBO therapy, because of a patient who developed a severe capillary leak syndrome. 31 Nonetheless, our FA patient underwent five treatments with HBO, with close monitoring during treatment, interrupting HBO after five sessions owing to pressure intolerance, without resolution of hematuria. After BMT, the patient developed bacteremia, refractory septic shock and multi-organic dysfunction syndrome and died 6 weeks after HSCT.…”

Hyperbaric oxygen as a treatment modality in cyclophosphamide‐induced hemorrhagic cystitis

“…It is prudent to ensure absence of any aerobic microorganism–related infections and inherited clastogenic disorders such as Fanconi anemia in patients being considered for this treatment . HBO2 increases the body ROI levels, and those susceptible to cellular DNA damage by these entities can manifest with tissue edema . Cystoscopy after about 20 to 30 sessions helps to guide further treatment if patients are hematopoietically stable and have evidence of engraftment by then.…”

Pediatric hemorrhagic cystitis

“…Besides logistic concerns of possible transfers and placing a likely immunosuppressed pediatric patient in a hyperbaric chamber, contraindications for HBO include active cancer and active viral infection which as previously discussed are commonly present in this patient population. Complications from HBO therapy have been reported in a patient with Fanconi anemia raising concerns regarding this modality in that subset of patients [84]. Additionally, the duration of therapy has not been elucidated in pediatric populations due to its limited application.…”