Hemopure Therapy in Postpartum Hemorrhagic Shock: Challenges in Laboratory Interference and Kidney Assessment

Introduction: HBOC-201 (Hemopure) is a second-generation hemoglobin-based oxygen carrier (HBOC) derived from bovine (cow) hemoglobin.It is intended to be used as an alternative when human blood is unavailable or unsuitable, such as in emergencies or when a patient refuses blood transfusion for religious or personal reasons. Challenges arise with its interference in laboratory tests, particularly in assessing renal function. Case Description: We describe the case of a previously healthy 35-year-old pregnant Jehovah's Witness who presented at 38 weeks gestation with placental abruption necessitating emergent cesarean section, leading to postpartum hemorrhagic shock with acute hemoglobin drop to 2.5 g/dL. Due to religious beliefs, she declined human blood products, prompting her transfer to a tertiary center for participation in a clinical trial of Hemopure therapy. The hospital course was further complicated by peripartum cardiomyopathy, ventilator-dependent respiratory failure, and non-oliguric acute kidney injury with refractory hyperkalemia, necessitating intermittent hemodialysis followed by continuous venovenous hemodiafiltration. However, despite regional anticoagulation, circuit clots resulted in further blood loss. Hemopure administration, erythropoiesis-stimulating agents, and intravenous iron were initiated. Hemopure use was complicated by inaccurate laboratory results, including creatinine, blood urea nitrogen, and potassium, due to interference with ion selective electrode, making the interpretation of laboratory parameters unreliable. Due to lack of accurate laboratory parameters, further decisions for renal replacement therapy remained solely on clinical grounds and indirect parameters (altered mental status, electrocardiogram, etc.). The patient's condition eventually improved, leading to extubation, improvement in kidney function, and rise in hemoglobin up to 10 g/dL, allowing discharge from the hospital. Discussion: This case highlights the complexity of managing postpartum hemorrhagic shock in Jehovah's Witness patients, necessitating alternative therapies like Hemopure. Its interference with laboratory tests poses significant challenges critical for guiding therapy, especially for nephrologists. Further research is imperative to elucidate Hemopure's impact on metabolic panel accuracy, aiding nephrologists in clinical decision-making.