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
- left ventricular
- heart failure
- end stage renal disease
- chronic kidney disease
- ejection fraction
- acute kidney injury
- patients undergoing
- prognostic factors
- adipose tissue
- stem cells
- hypertrophic cardiomyopathy
- bone marrow
- acute myocardial infarction
- patient reported
- mitral valve
- extracorporeal membrane oxygenation
- coronary artery disease
- electronic health record
- skeletal muscle
- risk factors
- mesenchymal stem cells
- percutaneous coronary intervention
- insulin resistance
- acute coronary syndrome
- left ventricular assist device