Use of hyperbaric oxygen therapy and PEGylated carboxyhemoglobin bovine in a Jehovah’s Witness with life-threatening anemia following postpartum hemorrhage

Early Experiences With PEGylated Carboxyhemoglobin Bovine in Anemic Jehovah’s Witnesses: A Case Series and Review of the Literature

“…In a separate case, a 43-year-old female JW patient presented with postpartum hemorrhage requiring iliac artery embolization and the administration of procoagulants and uterotonics. 18 The patient's hgb on POD1 declined to 3.0 g/dL from an admitting baseline hgb of 12.2 g/dL. The patient was paralyzed and administered hyperbaric oxygen, EPO, and IV iron.…”

“…The known mortality risk of severe anemia is compounded by the inability to rapidly increase oxygen-carrying capacity in JW patients secondary to their refusal of blood transfusions and the delayed bone marrow response to exogenous EPO. 7 Although there are alternative methods to reduce oxygen consumption and increase blood oxygenation, [17][18][19] HBOCs represent the only available pharmacotherapy capable of rapidly increasing oxygen-carrying capacity of JW patients in practice. 6 Despite their potential to improve tissue oxygenation, HBOCS are associated with risks as well.…”

“…8,15 Thus, the only efficacy data available in this population are in the form of observational studies. 3,11,18,[23][24][25] Mackenzie et al published a retrospective study of 54 patients with life-threatening anemia who refused blood transfusions and received HBOC-201 for compassionate use. 23 Included patients had evidence of anemia (hgb <6 g/dL) and signs of ongoing ischemia.…”

“…The published data for PEGylated carboxyhemoglobin bovine in anemic JWs are more limited. 18,21,25 A 22-year-old JW patient with thrombotic thrombocytopenic purpura who initially refused plasma exchange therapy on religious grounds developed anemia with hgb below 4 g/dL by day 10 of admission despite treatment with EPO, iron, and high-dose corticosteroids. 25 PEGylated carboxyhemoglobin bovine was requested and administered on 4 consecutive days, after which her hgb improved, and she was discharged in stable condition.…”

Targeting the Heme Oxygenase 1/Carbon Monoxide Pathway to Resolve Lung Hyper-Inflammation and Restore a Regulated Immune Response in Cystic Fibrosis

“…PP-007 is FDA-approved for compassionate care, and has been successfully used as an artificial oxygen transfusion agent in two patients undergoing surgery, a patient with thrombotic thrombocytopenic purpura and a woman with postpartum hemorrhage (Holzner et al, 2018;Brotman et al, 2019). Patients were eventually stabilized, and no adverse events were reported (Sam et al, 2017;Thenuwara et al, 2017). Given PP-007's cytoprotective effects and its use in ischemia-reperfusion injury in renal transplant patients (clinicaltrials.gov, ID: NCT02490202; Phase II/III), PP-007 may be able to prevent/reduce ischemiareperfusion injury in CF patients after lung transplant (Porteous et al, 2015).…”