Inhaled nitric oxide prevents systemic and pulmonary vasoconstriction due to hemoglobin-based oxygen carrier infusion: A case report

Francesco Marrazzo; Grant Larson; Tenzing T Sherpa Lama; Maddalena Teggia Droghi; Maurice Joyce; Fumito Ichinose; Michael T Watkins; Christopher Stowell; Jerome Crowley; Lorenzo Berra

doi:10.1016/j.jcrc.2018.04.008

Inhaled nitric oxide prevents systemic and pulmonary vasoconstriction due to hemoglobin-based oxygen carrier infusion: A case report

J Crit Care. 2019 Jun:51:213-216. doi: 10.1016/j.jcrc.2018.04.008. Epub 2019 Jan 30.

Authors

Affiliations

¹ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: FMARRAZZO@MGH.HARVARD.EDU.
² Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: GML35@PITT.EDU.
³ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: TTLAMA@PARTNERS.ORG.
⁴ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: m.teggiadroghi@gmail.com.
⁵ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: mfjoyce3@gmail.com.
⁶ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: FICHINOSE@MGH.HARVARD.EDU.
⁷ Department of Surgery, Vascular Surgery Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: MTWATKINS@PARTNERS.ORG.
⁸ Blood Transfusion Service, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: CSTOWELL@MGH.HARVARD.EDU.
⁹ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: JCCROWLEY@MGH.HARVARD.EDU.
¹⁰ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: LBERRA@MGH.HARVARD.EDU.

Abstract

Hemoglobin-based oxygen carriers (HBOCs) are used in extreme circumstances to increase hemoglobin concentration and improve oxygen delivery when allogenic red blood cell transfusions are contraindicated or not immediately available. However, HBOC-induced severe pulmonary and systemic vasoconstriction due to peripheral nitric oxide (NO) scavenging has stalled its implementation in clinical practice. We present a case of an 87 year-old patient with acute life-threatening anemia who received HBOC while breathing NO gas. This case shows that inhaled NO allows for the safe use of HBOC infusion by preventing HBOC-induced pulmonary and systemic vasoconstriction.

Keywords: Hemoglobin based oxygen carrier (HBOC); Nitric oxide; Vasoconstriction.

Publication types

Case Reports

MeSH terms

Aged, 80 and over
Anemia / complications*
Blood Substitutes / adverse effects*
Female
Humans
Lung / drug effects*
Nitric Oxide / administration & dosage*
Oxygen / blood
Oxyhemoglobins / adverse effects*
Respiration / drug effects
Vasoconstriction / drug effects*

Substances

Blood Substitutes
Oxyhemoglobins
Nitric Oxide
Oxygen

Grants and funding

K23 HL128882/HL/NHLBI NIH HHS/United States