Difficult to swallow: warm autoimmune hemolytic anemia in a Jehovah's Witness treated with hemoglobin concentrate complicated by achalasia

BACKGROUNDThe acute treatment of severe warm autoimmune hemolytic anemia (wAIHA) is focused on maximizing the oxygen delivery capacity of the patient's circulation and reversal of the underlying autoimmune process. The most effective means of preventing ischemic injury acutely is replacement of red blood cells (RBCs) via allogeneic RBC transfusion. However, in cases where this is not an option, other strategies must be considered including the use of hemoglobin-based oxygen carriers (HBOCs). CASE REPORTHerein we present a case of a 70-year-old Jehovah's Witness with wAIHA who required emergent HBOC-201 to prevent life-threatening decompensation. The treatment was complicated by hypertension and achalasia likely related to the nitric oxide scavenging effects of HBOC-201. These side effects were managed appropriately, and the patient ultimately recovered. CONCLUSIONEarly recognition of the need and ready familiarity with its properties on the part of the physician are critical to the utilization of HBOC-201 in a safe and timely fashion.