Physicians offer new solution for blood transfusions

The successful transfusion of a cell-free blood product on a 14-year-old Jehovah’s Witness may offer a solution for patients opposed to blood transfusions due to religious or personal beliefs.

“This was the first successful use of a human cell-free hemoglobin solution in a pediatric patient to manage life-threatening anemia due to an autoimmune disease,” says Dr. Brian Kavanagh, professor of medicine at the University of Toronto and staff physician in critical care medicine at The Hospital for Sick Children. The patient suffered from immune thrombocytopenia, a condition that attacks platelets in the body. Platelets are present in blood and help blood clot; if platelet counts are very low, minor injuries or trauma can become very serious if the patient continues to bleed.

Kavanagh and colleagues Drs. Johann Hitzler and Natalie Anton treated the patient last year after she entered the hospital’s emergency room for a nosebleed that did not stop. Instead of a blood transfusion, they used a biochemically manufactured solution that contains hemoglobin but does not contain red blood cells. The solution has been used in adults but never for a child in this kind of situation, Kavanagh says.

While more study needs to be done with pediatric patients, Kavanagh says this cell-free hemoglobin is a viable alternative for Jehovah’s Witnesses. “Most current blood replacement options are fluids, plasma and other types of liquids that provide volume for blood but don’t provide the oxygen-carrying capacity. This solution provides oxygen-carrying capacity in exactly the same way that blood cells in hemoglobin do. That’s the crux of the matter. Still, only careful study will fully determine the balance of benefits and risk.”

Kavanagh and colleagues reported this case in a fall issue of the British Journal of Haematology.

CONTACT: Dr. Brian Kavanagh of medicine at U of T and The Hospital for Sick Children, 416-813-6860, brian.kavanagh@sickkids.ca
or Janet Wong, U of T public affairs, 416-978-5949, jf.wong@utoronto.ca