title: Pegylated bovine carboxyhaemoglobin utilisation in a thrombotic thrombocytopenic purpura patient.
abstract: OBJECTIVE
  To determine if pegylated bovine carboxyhaemoglobin can be utilised in a thrombotic thrombocytopenic purpura (TTP) patient.
  
  
  BACKGROUND
  TTP is a condition characterized by thrombotic microangiopathy and has a high mortality rate when left untreated. Therapeutic plasma exchange is well established as the most effective and evidence-based treatment of TTP.
  
  
  METHODS
  The ability to administer plasma exchange therapy is limited in Jehovah's Witnesses who decline blood products due to religious beliefs. Pegylated bovine carboxyhaemoglobin is a novel oxygen transfer agent in development for the management of complications of ischaemia due to acute anaemia.
  
  
  RESULTS
  Treatment was well tolerated, with grade 1 paresthesia of the right face and arm 1 h after the first infusion of Sanguinate, which spontaneously resolved and did not recur, and grade 1 cardiac troponin elevation after receiving the medication (with peak at 0·079 ng mL-1), but further workup with electrocardiogram and echocardiogram was unremarkable. By discharge on day 19, the patient's haemoglobin increased to 8·8 g dL-1and platelet count to 221 000.
  
  
  CONCLUSIONS
  We report the first case of TTP in a Jehovah's Witness that was successfully managed with the use of pegylated bovine carboxyhaemoglobin as an adjunct medication.
authors.affiliation: Department of Hematology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
authors.forename: C
authors.initials: C
authors.lastname: Sam
authors.affiliation: Department of Hematology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
authors.forename: P
authors.initials: P
authors.lastname: Desai
authors.affiliation: Department of Hematology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.|Department of Hematology & Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: D
authors.initials: D
authors.lastname: Laber
authors.affiliation: Department of Hematology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.|Department of Hematology & Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Hematology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
authors.forename: N
authors.initials: N
authors.lastname: Visweshwar
authors.affiliation: Department of Hematology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.|Department of Hematology & Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-4305-2535
authors.initials: M
authors.lastname: Jaglal
mesh_terms: D000328:Adult; D000818:Animals; D001802:Blood Substitutes / Q000008:administration & dosage*; D002263:Carboxyhemoglobin / Q000008:administration & dosage*; D002417:Cattle; D005260:Female; D006801:Humans; D033221:Jehovah's Witnesses; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000628:therapy*
chemical_list: D001802:Blood Substitutes; D002263:Carboxyhemoglobin
keywords: TTP; blood substitute; plasma exchange