針對一名耶和華見證者的案例:高壓氧療法成功治療嚴重失血性貧血

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一名39歲的女性在妊娠期間因胎盤早剝導致嚴重失血性貧血,其血紅素僅為1.9 g/dL。由於宗教信仰拒絕輸血,患者接受了30次高壓氧療法(HBO),顯著改善了其腎功能和血液指標。最終,她在住院第35天出院,未出現神經或認知損傷,這一案例顯示高壓氧療法在處理嚴重失血性貧血中的潛力。

Severe blood loss anemia in a Jehovah’s Witness treated with adjunctive hyperbaric oxygen therapy

接受輔助高壓氧治療的耶和華見證人患者之嚴重失血性貧血案例

Graffeo C, Dishong W. Severe blood loss anemia in a Jehovah’s Witness treated with adjunctive hyperbaric oxygen therapy. Am J Emerg Med. 2013;31(4):756.e3-756.e756004. doi:10.1016/j.ajem.2012.11.013

https://pubmed.ncbi.nlm.nih.gov/23380087/

Abstract

We describe the case of a 39-year-old African-American woman who experienced sudden onset, near-term placental abruption resulting in severe blood loss anemia. Her religious beliefs, as a Jehovah’s Witness, precluded the use of blood products. The patient lost most of her blood volume, with a hemoglobin level of 1.9 g/dL, and developed multisystem failure, disseminated intravascular coagulation, and bilateral deep venous thrombosis. Adjunctive hyperbaric oxygen (HBO) therapy was initiated. She required ventilatory support, vasopressors, and hemodialysis. HBO therapy was administered at 2.0 atmospheres absolute for 90 minutes per session, up to twice daily based on her clinical status. A total of 30 HBO treatments were given, resulting in sustained improvement in hemodynamic parameters, red blood cell volume, renal, and respiratory function. She was discharged to a rehabilitation facility on hospital day 29 and later to her home. Upon discharge, the patient showed no signs of physical or cognitive impairment, and no complications from HBO therapy were reported. Adjunctive HBO therapy should be considered for managing severe blood loss anemia in patients who refuse blood products.

A 39-year-old gravida 2 para 1 woman developed sudden severe abdominal pain at 36 weeks and 1 day of gestation. She denied vaginal bleeding and was transported to the labor and delivery unit. Upon arrival, the patient underwent examination and bedside ultrasound, which confirmed fetal demise. She had a blood pressure of 156/92 mm Hg, heart rate of 96 beats/min, and respirations of 18 breaths/min. The patient was diagnosed with abruptio placenta and underwent emergency cesarean delivery, during which she lost approximately 2 liters of blood. Her hemoglobin level dropped to 1.9 g/dL post-operatively, and she developed disseminated intravascular coagulation and multiple organ failures.

Given her severe anemia and refusal of blood products, HBO therapy was considered. Over her 29-day hospital stay, the patient underwent a total of 30 HBO treatments, leading to improvements in her renal and respiratory function, lactic acidosis, vasopressor requirements, and hemoglobin levels. By hospital day 35, her hemoglobin reached 6.3 g/dL, and she was discharged in stable condition without neurological or physical impairment. No complications were associated with HBO therapy.

HBO therapy in severe blood loss anemia dates back to 1959, and while there are limited case reports, its efficacy is supported by improvements in tissue perfusion and inhibition of inflammatory cytokines under hyperbaric conditions. This case demonstrates the potential benefits of adjunctive HBO therapy in managing severe blood loss anemia, particularly in patients who refuse blood transfusions.

摘要

我們描述了一名 39 歲非裔美國女性的病例,她發生了突發性、近足月的胎盤早期剝離,導致嚴重失血性貧血,並因宗教信仰拒絕接受任何血液製品。該患者失去了大部分血容量,血紅素報告值僅為 1.9 g/dL,發展為多系統衰竭及瀰漫性血管內凝血,並伴有雙側深靜脈血栓。考慮到患者的情況,轉介進行輔助高壓氧(HBO)治療。患者需要呼吸機支持、升壓劑及透析治療。HBO 治療在單艙高壓氧環境下進行,每次治療在 2.0 大氣壓下持續 90 分鐘,每天最多進行兩次,依據患者臨床狀況而定。患者共進行了 30 次 HBO 治療,血液動力學參數、紅血球體積、腎功能和呼吸功能均持續改善。她於住院第 29 天出院至康復機構,不久後回家。出院時,患者沒有持續的身體或認知損傷,且無報告與 HBO 治療相關的併發症。輔助 HBO 治療應被考慮用於拒絕血液製品的患者,以處理嚴重失血性貧血。

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