Applications of Hyperbaric Oxygenation in anemias due to acute blood loss

The first time that HBOT was used as adjunctive therapy in the treatment of anemia due to acute blood loss was in 1974 by Dr. Hart. However, since the 60’s it had been used for vascular collapse with very promising results.

When a patient loses a sufficient amount of blood it can compromise the adequate distribution of oxygen in the tissues and the survival of the patient, unless the circulating volume is restored and the ability to meet the local and systemic oxygen requirements.

There are medical conditions (group incompatibility, idiopathic autoimmune hemolytic anemia, hepatitis and HIV) and religious (Jehovah’s Witnesses) that can delay or prevent the restitution of blood or its derivatives in some patients. Great advances have been made in blood substitutes (fluorocarbon), although it has not been possible to develop an ideal blood substitute and still has some deficiencies in its use, toxicity, short life and interference with the immune system.

HBOT is a short-term adjunctive treatment effective for the management of patients with acute anemia due to blood loss. Unfortunately, the patient cannot be subjected indefinitely to hyperbaric oxygenation, as it can develop pulmonary oxygen toxicity. However, the intermittent exposure to HBOT of these patients helps to maintain the viability of organs (brain, heart, etc.) and of the patients themselves, until the marrow produces sufficient Hb to maintain the basic requirements of oxygenation.

Hyperbaric oxygenation is indicated in the management of this pathology under the following conditions:

  • Patients who do not have immediate availability of a group
  • Patients who for religious reasons do not accept blood transfusions or their derivatives
  • When the patient has a systolic blood pressure less than 90 mmHg and requires the use of vasopressors to maintain the average blood pressure
  • When there is alteration of the mental state and / or coma
  • With myocardial ischemia data in the ECG
  • With intestinal and / or hepatic ischemia data
  • When there is data of severe lactic acidosis.

The protocol used for the management of anemia due to acute blood loss must include the patient’s life support, medical and surgical management, depending on the case.

Hyperbaric oxygenation is discontinued when the patient no longer presents data of moderate respiratory insufficiency, when hemoglobin reaches levels of 6-8 g / dl, the hematocrit is around 22.9% and the reticulocyte count is 8.2%. The increasing experience in the management of these patients has shown that survival depends on the haste with which resuscitative maneuvers are initiated and treatment with HBO. In Class IV hemorrhages, 70% survival has been achieved; however, when patients are referred in a timely manner, mortality is less than 5%.

The application of hyperbaric oxygenation, when performed early in combination with other treatments, reduces morbidity and mortality, hospital stay, the need for surgery and its complications, reduces the number of amputations and the total cost of medical attention. Hyperbaric oxygenation is a treatment that can save patients with anemia due to acute blood loss where blood volume cannot be restored due to medical or religious circumstances. Its cost benefit in these patients is very high.

Source

E. Cuauhtémoc. 2000. Applications of Hyperbaric Oxygenation in anemias due to acute blood loss. Virtual Journal of Hyperbaric Medicine.

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