Prolonged tissue oxygenation and maintenance of intravascular oncotic pressure are severely impaired with the absence of an effective RBC mass. We recently encountered a patient with a nondetectable hematocrit value (0%) attributed to Clostridium perfringens hemolysis. The patient maintained normal BP, tissue oxygenation, and mentation and survived longer than four hours, despite ineffective transfusion therapy. Plasma free hemoglobin was responsible for the preservation of tissue oxygenation, intravascular oncotic pressure, and pH. Existing studies in animals support stroma-free hemoglobin as an effective blood product in humans.
Terebelo HR, McCue RL, Lenneville MS. Implication of Plasma Free Hemoglobin in Massive Clostridial Hemolysis. JAMA. 1982;248(16):2028–2029. doi:10.1001/jama.1982.03330160076029
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