Mechanical Blood Trauma in Circulatory-Assist Devices
8. Medical therapy for elevated plasma free hemoglobin
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In the instance of elevated free Hb induced by a mechanical circulatory support device, there is no specific pharmacologic therapy to increase the clearance of the plasma free hemoglobin. However, there have been studies that show use of glucocorticoids can increase the levels of haptoglobin, which is among the main mechanisms for clearance under normal physiology. Such therapy might be considered for moderate increases in free Hb to keep levels below critical limits (see Table 7-1). Other reported pharmacotherapies have involved the use of pentoxifylline to prevent hemolysis in cardiopulmonary bypass and in a VAD patient with ongoing hemolysis. The exact mechanism of action for pentoxifylline is not entirely clear but it has been reported to increase red cell deformability and reduce blood viscosity. For these reasons, it is typically used in patients who have arterial occlusive diseases including sickle cell anemia.