Use of the blood substitute HBOC-201 in critically ill patients during sickle crisis: a three-case series

Jonathan M. Davis, Nora El-Haj, Nimish N. Shah, Gary Schwartz, Margaret Block, James Wall, Mark Tidwell, Ernest DiNino

In patients for whom blood transfusions are not an option, those with sickle cell disease face a particularly high risk for severe anemia, morbidity and mortality. Especially when complicated by multiple organ failure.
This paper highlights the importance of more research into innovative ways to treat this particular population of patients who at their baseline healthy state are often already considered anemic.

Hgb alternatives like HBOC-201 are apparently the next frontier in patient blood management solutions in cases where blood transfusions are precluded.

In each case presented, use of the Hgb alternative led to an increase of almost double the Hgb level, but never up to the admission levels.There might be concerns about the volumes involved, but these units serve an essential function just as large volumes for fluid resuscitation do (e.g. normal saline).

In short order, we might expect that a standard algorithm for use of HBOC-201 and similar therapies will be developed and implemented. The protocol developed by Dr Shander referred to in the paper has a required maximum Hgb level before the Hgb alternative can be used. Possibly that value could be raised in cases of SCD patients, and adjusted according to specific disease states.