title: Management of acute anemia in a Jehovah's Witness patient with acute lymphoblastic leukemia with polymerized bovine hemoglobin-based oxygen carrier: a case report and review of literature.
abstract: BACKGROUND
  Management of severe symptomatic anemia is exceptionally challenging when blood transfusions cannot be administered. Use of hemoglobin (Hb)-based oxygen carriers as "bridging treatment" can be an option.
  
  
  METHODS
  This is a report of a 36-year-old Jehovah's Witness diagnosed with acute lymphoblastic leukemia (ALL) who developed severe symptomatic anemia (Hb as low as 3.1 g/dL) during induction chemotherapy and refused allogeneic blood transfusions. Fifteen units of Hemopure (Biopure Corp.), an investigational polymerized bovine Hb-derived artificial oxygen carrier, were administered over a 12-day period after informed consent was obtained. The patient's condition improved.
  
  
  RESULTS
  Chart review was performed to identify relevant information about the patient's clinical status during Hemopure treatment. With the use of Hemopure the patient's total Hb level was maintained between 3.6 and 5.3 g/dL, over a 12-day period, without any evidence of ischemia or organ dysfunction indicating that Hemopure was providing adequate tissue oxygen supply until marrow red blood cell recovery. The patient completed the chemotherapy regimen and was discharged in stable condition and has been in remission for 28 months.
  
  
  CONCLUSIONS
  This report documents the successful management of profound anemia in an acute leukemia patient who refused blood transfusion, with the use of Hemopure, to save the patient from the devastating effects of ischemia associated with severe anemia. Hemopure may represent a life-saving intervention in patients with severe symptomatic anemia when blood transfusion is not an option.
authors.affiliation: Monter Cancer Center, North Shore-LIJ Health System, Hofstra University School of Medicine, New York 11042, USA. ldonahue@nshs.edu
authors.forename: Laura L
authors.initials: LL
authors.lastname: Donahue
authors.forename: Iuliana
authors.initials: I
authors.lastname: Shapira
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shander
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kolitz
authors.forename: Steven
authors.initials: S
authors.lastname: Allen
authors.forename: Gerson
authors.initials: G
authors.lastname: Greenburg
mesh_terms: D000208:Acute Disease; D000328:Adult; D000740:Anemia / Q000188:drug therapy*; D001802:Blood Substitutes / Q000627:therapeutic use*; D005260:Female; D006454:Hemoglobins / Q000627:therapeutic use*; D006801:Humans; D033221:Jehovah's Witnesses; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000150:complications* / Q000188:drug therapy
chemical_list: D001802:Blood Substitutes; D006454:Hemoglobins; C096798:HBOC 201