Hematopoietic Stimulation During Impella 5.5 Support to Avoid Transfusions in a Jehovah's Witness.
Robert DevichNina Rosa NeuendorffOscar Howard FrazierHoward J EisenRobert DowlingMiriam FreundtPublished in: ASAIO journal (American Society for Artificial Internal Organs : 1992) (2023)
The population presenting with cardiogenic shock is heterogenous. Anemia is common in advanced heart failure and associated with poor outcomes. Microaxial flow pumps may cause ongoing blood trauma and worsen anemia. Treatment with recombinant erythropoietin, iron, vitamin B, and folate is recommended before cardiac surgery to reduce perioperative transfusion requirements but no data exist on the feasibility and safety during support with microaxial flow pumps. This novel strategy was born out of necessity to support a Jehovah's Witness who opposes blood transfusion but required mechanical circulatory support. We present its efficacy over the duration of 19 days of Impella 5.5 support where hemoglobin level remained stable, and platelet count significantly improved despite a brief episode of gastrointestinal bleeding. No thromboembolic complications occurred. We anticipate this strategy could help not only Jehovah's Witnesses, but also patients awaiting cardiac transplantation since transfusions stimulate development of antibodies which may preclude or postpone finding a suitable donor organ. Furthermore, it may minimize or prevent perioperative needs for transfusions for patients being bridged to durable left ventricular assist devices.
Keyphrases
- cardiac surgery
- end stage renal disease
- chronic kidney disease
- heart failure
- left ventricular
- ejection fraction
- extracorporeal membrane oxygenation
- newly diagnosed
- acute kidney injury
- patients undergoing
- machine learning
- peritoneal dialysis
- aortic stenosis
- risk factors
- electronic health record
- cardiac resynchronization therapy
- atrial fibrillation
- peripheral blood
- bone marrow
- data analysis
- big data
- acute coronary syndrome
- cell free