Objective: To present the successful management of a foal with severe neonatal isoerythrolysis (NI) given polymerized (bovine) hemoglobin while awaiting appropriate red blood cells for transfusion.
Case Summary: A foal with peracute neonatal isoerythrolysis, anemia and low venous oxygen tension was stabilized with intravenous polymerized hemoglobin. Polymerized hemoglobin treatment maintained the foal's oxygen requirement for up to 18 hours permitting adequate time for preparation of the donor's washed red blood cells for transfusion. The clinical findings and venous oxygen tension improved following the hemoglobin administration. No adverse effects were noted from the polymerized hemoglobin administration.
Unique information provided: This paper presents a foal with an uncommon cause of NI due to anti-Pa antibodies and the short term management of NI using polymerized hemoglobin while awaiting a washed and packed RBC transfusion. Clinical and laboratory findings (trigger factors), which can be used to determine the need for a blood transfusion, are discussed. These “trigger factors” include weakness, tachypnea and tachycardia, increased anion gap and decrease in hematocrit, hemoglobin concentration and mixed venous (pulmonary artery) oxygen tension (approximated using jugular venous samples). (J Vet Emerg Crit Care 2001; 11(2): 141–146)