Bovine blood and neuromuscular paralysis as a bridge to recovery in a patient with severe autoimmune hemolytic anemia.

Hemoglobin solutions have several advantages as substitutes for erythrocyte transfusions. They have a prolonged shelf life, do not require cross-matching, are associated with few transfusion reactions, and are effective in delivering oxygen to the tissues. Despite the potential clinical utility of these solutions, they have not achieved widespread use. HbOC-201 (Hemopure, Biopure, Cambridge, MA, USA) is a bovine hemoglobin solution that has been FDA approved for compassionate use in Jehovah's witness patients requiring transfusions. Here we report a case of a patient with hemoglobin H disease who developed a severe life-threatening mixed warm and cold antibody mediated autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) who was successfully treated with HbOC-201 as an adjunct to blood transfusion.