Jordan Shane D, Alexander Earnest
Tampa General Hospital, Tampa, FL, USA.
J Pharm Pract. 2013 Jun;26(3):257-60. doi: 10.1177/0897190012451928. Epub 2012 Aug 6.
Management of severe symptomatic anemia in critically ill Jehovah's Witness patients remains a challenge. The paucity of therapeutic alternatives to human red blood cells has prompted the use of blood substitutes.
A 19-year-old female Jehovah's Witness patient presented to the emergency department following several episodes of syncope. She was found to have a positive Coombs test and was diagnosed with warm-bodied autoimmune hemolytic anemia. Upon admission, her hemoglobin was 8.4 g/dL, then dropped to a nadir of 2.8 g/dL 4 days later. She received traditional management with corticosteroids, intravenous immune globulin, rituximab, and partial splenic artery embolization. Despite these therapies, hemoglobin levels failed to respond, and she experienced signs of marked ischemia. A decision was made to give 2 units of Hemopure, a bovine hemoglobin-based oxygen carrier, and the hemoglobin levels increased to 8.7 g/dL 10 days later. The patient's overall clinical condition improved leading to subsequent hospital discharge.
This case exemplifies the ingenuity that health care practitioners must use in critical situations involving the medical management of anemic Jehovah's Witness patients who refuse blood products. Hemopure was used as "bridging treatment" to help save a patient from the devastating effects of ischemia resulting from severe anemia.
对危重症耶和华见证会患者的严重症状性贫血进行管理仍然是一项挑战。由于缺乏替代人类红细胞的治疗选择，促使人们使用血液替代品。
一名19岁的耶和华见证会女性患者因多次晕厥被送往急诊科。她的库姆斯试验呈阳性，被诊断为温抗体型自身免疫性溶血性贫血。入院时，她的血红蛋白为8.4 g/dL，4天后降至最低点2.8 g/dL。她接受了皮质类固醇、静脉注射免疫球蛋白、利妥昔单抗和部分脾动脉栓塞的传统治疗。尽管采取了这些治疗措施，血红蛋白水平仍无反应，她出现了明显的缺血迹象。决定给予2单位的Hemopure（一种基于牛血红蛋白的氧载体），10天后血红蛋白水平升至8.7 g/dL。患者的整体临床状况有所改善，随后出院。
本病例体现了医护人员在涉及拒绝输血制品的贫血耶和华见证会患者医疗管理的危急情况下必须运用的智慧。Hemopure被用作“桥梁治疗”，以帮助患者避免因严重贫血导致的缺血性灾难性后果。
