The effect of hyperbaric oxygen on severe anemia
Louisiana State University-Health Sciences Center, Department of Medicine, Section of Emergency Medicine, New Orleans, Louisiana, USA.Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc (Impact Factor: 0.77). 09/2012; 39(5):937-42.
As a respiratory pigment, hemoglobin allows blood to carry unnaturally high levels of nascent, molecular oxygen at one atmosphere of pressure in chemical solution to capillary beds and post-capillary venules supplying parenchymal cells of all organ systems in the body. When hemoglobin drops to critical levels to disallow proper oxygen delivery, hyperbaric oxygen therapy may be used as bridge therapy to emergently supply oxygen. Hyperbaric-administered oxygen allows oxygen to be dissolved in increased concentration in red blood cell-poor plasma or crystalloid/ colloid-diluted intravascular fluids in a volume-resuscitated patient. Additionally in both subacutely and chronically anemic patients, pulsed, intermittently provided normobaric or hyperbaric oxygen induces an increase in red blood cell/hemoglobic mass. Transfusions of separate donor red blood cells are transplantations of tissue not uncomplicated by immunomodulatory reactions. In the long term, autologous blood products may be less problematic than transfused, homologous packed red blood cells to reduce patient oxygen debt in illness or injury. Hyperbaric oxygen can reduce oxygen debt decisively in the polar clinical extremes of exsanguination with cardiopulmonary arrest all the way to resuscitation of the severely anemic patient who cannot be transfused with red blood cells for religious reasons, immunologic reasons, or blood availability problems. A hyperbaric oxygen treatment is equivalent in wholesale cost to a unit of packed red blood cells in the western world. By controversy, but true, hyperbaric oxygen provides a low-technology, cost-competitive means of pharmacologically reducing accumulated oxygen debt in the anemic, injured or critically ill patient with little side effect. To address severe anemia in trauma or illness, the future may well afford the use of hyperbaric oxygen therapy in the military far-forward, in pre-hospital EMS settings, in trauma center emergency departments, in operative and recovery units, and in intensive care units of hospitals.
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ABSTRACT: Despite the widespread use of allogeneic blood components in clinical practice, there are patients in whom transfusion cannot be carried out for various reasons, including refusal of transfusions because of religious beliefs. The refusal of transfusion is not equivalent to refusal of medical treatment, and numerous options are available to effectively manage care without transfusions. The strategies are collectively called Bloodless Medicine and Surgery and share many similarities with Patient Blood Management, that is, application of evidence-based medical and surgical concepts designed to preserve patient's own blood to improve the outcomes of patients. The strategies involve obtaining advance directive and consent to determine what components and procedures are acceptable to the patient; preoptimizing the patient for early correction of treatable deficiencies (e.g., anemia, coagulopathy); minimizing blood loss (e.g., hemostatic agents, blood salvage); and improving physiologic responses to anemia. Using these approaches, it is possible to effectively manage patients, with outcomes comparable to patients who accept transfusions.
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ABSTRACT: In situations involving serious bleeding and anaemia, a refusal of blood transfusion puts the clinician in an ethical and medical dilemma, as standard treatment is not an option, and the patient risks dying of a potentially reversible cause. This status article describes methods of treatment under the concept of "bloodless medicine", where surgical and supportive techniques are used to manage and treat severe anaemia.
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