Hemoglobin infusion

HCN in the blood is almost completely contained in the red blood cells where it is bound to methemoglobin. Immediately after infusion of sodium nitroprusside into patients, 98.4% of the blood cyanide was found in the red blood cells (Vesey et al. 1976). At normal physiological levels of body methemoglobin (0.25% to 1% of the hemoglobin), a human adult can bind about 10 mg of HCN (Schulz 1984). 

Figure 4 A set of gamma camera images of a rabbit intravenously injected with Tc-99m-LEH. Twenty-five percent of blood was exchanged with liposome-encapsulated hemoglobin (LEH) (hypovolemic) and the animal was imaged using a gamma camera at various times after infusion. The images clearly show a prolonged circulation of LEH as evidenced by the continued grayscale intensity in heart.

White CT, Murray AJ, Greene JR, et al. Toxicity of human hemoglobin solution infused into rabbits. J Lab Clin Med 1986 108 121. 

Adults - 10 mL (elemental iron 125 mg), may be diluted in 100 mL 0.9% sodium chloride administered by intravenous (IV) infusion over 1 hour. It may also be administered undiluted as a slow IV injection (at a rate up to 12.5 mg/min). Most patients will require a minimum cumulative dose of 1 g elemental iron administered over 8 sessions at sequential dialysis treatments to achieve a favorable hemoglobin or hematocrit response. Patients may continue to require therapy with IV iron at the lowest dose necessary to maintain the target levels of hemoglobin, hematocrit, and laboratory parameters of iron storage within acceptable limits. 

Adverse Reactions Nausea Facial swelling Pruritus Vomiting Anaphalaxis Rash Fever Increased ALT Increased AST Decreased hematocrit Decreased hemoglobin Increased serum alkaline phosphatase Infused vein complications... 

Glucocerebrosidase injections were then resumed in this patient, hut at a dose of 30 U/kg body weight each week. In comparison with the responses observed at a dose of 9-12 U/kg body weight, the hemoglobin rose at a more rapid rate with the higher dose infusions and ultimately returned to a fully normal value (Fie. 5). In addition, serum acid bhoanhatase fFia. 6) and nlasma... 

Chocolate agar is a polypeptone or beef infusion agar enriched with 2% hemoglobin released from defibrinated heated rabbit s or sheep s blood. The blood hemolysis creates the chocolate color. Free hemin and nicotinamide... 

Brauer, P. Standi, T. Wilhelm, S. Burmeister, M.-A. Schulte am Esch, J. Transcranial doppler ultrasonography mean flow velocity during infusion of ultrapurified bovine hemoglobin. J. Neurosurg. Anesthes 1998, 10 (3), 146-152. 

Intravenous dimethylsulfoxide poses the greatest problems and causes transient systemic hemolysis with hemoglobinuria, but without gross hematuria. The hemolysis is dose-dependent and appears within several minutes after infusions of dimethylsulfoxide 20-40% (11). There was no evidence of kidney damage because of handling higher amounts of hemoglobin after hemolysis. 

A 46-year-old woman took fenfluramine for 5 months without incident. Some time later she restarted therapy and after 2 months developed a hemoglobin concentration of 5.1 g/dl, a reticulocyte count of 8.6%, a white cell count of 17.1 x 10 /1, and a positive direct Coombs test, with IgG rhesus antibodies (anti-e and anti-nl). Fenfluramine was withdrawn and the Coombs test became negative and the patient recovered after prednisolone infusion. 

A wide range of adverse effects of ibritumomab has been reported. Most were hematological, thrombocytopenia being the most common, followed by a low hemoglobin and leukopenia. The most common non-hematological events were related to infusion and were similar to those reported with rituximab they included weakness (54%), nausea (35%), chills (15%), and fever (21%) (2,3). Infectious complications during treatment with ibritumomab are rare, pneumonia being the most common. There is no obvious hepatotoxicity. 

Both amyl nitrite and sodium nitrite oxidize the ferrous iron in hemoglobin, creating measurable levels of methemoglobin. Patients receiving sodium nitrite infusions require close require constant monitoring of blood pressure and close observation for cyanosis and shock, both manifestations of methemoglobinemia. 

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