New approach to management of life-threatening bleeding in a Jehovah’s Witness.

Hickey R
Crit Care Med 2002;30(8):1930-1931.
NATA Rating :
Review by : Hardy JF
NATA Review
This is an editorial on an article we commented previously (Gannon et al. Crit Care Med 2002;30:1893-5). The author reviews a number of interesting points on rHuEPO and oxygen therapeutics. He then comments on the role of HBOC-201 (the hemoglobin solution used to resuscitate this patient) in the final demise of the patient, who died of sepsis. The editorialist mentions the possible role of hemoglobin solutions in promoting infectious complications, given the speculation that “cell-free hemoglobin substances may support bacterial virulence by offering a supply of iron, sustaining bacterial replication and inhibiting neutrophil function.” Thus, as mentioned previously, oxygen transport comes at a price and these molecules are associated with a number of adverse effects. The question is to determine if, in the long run, these outweigh any beneficial effect on oxygen dynamics.

– J.-F. Hardy