Oxyglobin Solution Case: Gretchen

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Oxyglobin Solution Case Gretchen
Not eating4 days Not moving2 days PCV
18 DiagnosisIMHA
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Oxyglobin Solution Case Gretchen
2 hours later 200 mL of Oxyglobin(5
ml/kg) Physical ConditionImproving
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Oxyglobin Solution

• 13 g/dL polymerized, purified Hb in a modified
  LRS
• pH 7.8
• Isosmotic
• Molecular Weight (MW) 65 - 500 kD
• Average MW 200 kD
• Oxygen affinity chloride ion dependent

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How Oxyglobin Works
Normal Blood Flow andOxygen Delivery
Anemic Blood Flow and Oxygen Delivery
Anemic Blood Flow After Oxyglobin Administration
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Oxyglobin Utilizes The Plasma Space
Capillary Wall Red Blood Cell
Oxyglobin
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Hemoglobin - Oxygen Equilibrium
RBC
Oxyglobin
Sat
Arterial p02
Venous p02
Plasma
p02 (mm Hg)
P50 Oxyglobin 38 vs RBC 27
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Flexible Dosing of Oxyglobin Solution
Duration of effect (hours) 11-23 23-39 66-70 74
-82
Cleared from Plasma (days) 4-5 4-6 5-7 5-9
Dose (ml/kg) 10 15 21 30
Half-life (hours) 18-26 19-30 25-34 22-43
Oxyglobin levels gt1g/dL. Range based on
estimated mean value with bounds of 95
prediction interval.
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Determinants of Oxygenation
Oxygen Delivery (DO2)
Oxygen Content (CaO2)
Cardiac Output (CO)
X
Hemoglobin
Stroke Volume X Heart Rate
RBC
Plasma
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Oxygen TransportMechanism of Action

• Improves O2 convection
• increases O2 content in plasma
• decreases blood viscosity
• Improves O2 diffusion
• increases distribution of O2 in microcirculation
• increases O2 extraction from RBC
• increases pulmonary diffusing capacity

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2
1 Page TC et al. Oxygen Transport by
Erythrocyte/Hemoglobin Solution Mixtures in an in
Vitro Capillary as a Model of Hemoglobin-Based
Oxygen Carrier Performance. Microvascular
Research. 5554-64, 1998. 2 Hughes GS et al.
Hemoglobin-based Oxygen Carrier Preserves
Submaximal Exercise Capacity in Humans. Clin
Pharmacol Therap. 58(4)434-443, 1995.
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Restoring Oxygenation
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Hypoxia due to 95 Arterial Stenosis
95 STENOSIS
NORMAL
95 STENOSIS HETASTARCH
95 STENOSIS HBOC
pO2 (torr)
Horn, EP et al. Bovine Hemoglobin Increases
Skeletal Muscle Oxygenation During 95 Artificial
Arterial Stenosis. Surgery. 121 (4) 411-418,
1997.
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Fluid Characteristics
Viscosity
COP
Electrolytes
Osmolality
pH
(Centipose)
(mmHg)
(MOsm/L)
LRS
0.85
NA
Na, K,
Cl
275
6.7
0.9 NaCl
NA
NA
Na, Cl
308
5.0
Hypertonic
NA
NA
Na,
Cl
1712
5.0
Saline
6
4.3
30
Na,
Cl
310
5.5
Hetastarch
Dextran-70
3.68
65.8
Na,
Cl
310
3-7
with saline
Blood
3.6
25-30
Na, K,
Cl
300
Variable
Oxyglobin
1.3
37
Na, K,
Cl
300
7.8
Solution
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When Should I Use Oxyglobin?
IMHA and Trauma are Just the Tip of the Iceberg

• IMHA

• Trauma

• Anemia Occurring In
• Renal Failure
• GI Ulcers
• Concomitant Chemotherapy
• Previous Transfusion History
• Geriatric Dentistry
• Babesiosis
• Neoplasia
• Snake Bite
• Onion Toxicity
• Gun Shot Wounds
• Zinc Anemia
• Hemobartonella

• Rodenticide
• Tick Anemia
• Flea Anemia
• Hookworm
• Parvo Virus
• Hemmorhagic Shock
• Iron Deficiency
• Bone Marrow Disease
• Surgical Applications
• Splenectomy
• Mammary Tumor
• Pyometra
• C-section
• Amputations

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What to Expect with Oxyglobin Solution

• Improvement in clinical signs
• Increase in hemoglobin
• Decrease in hematocrit
• Discoloration of mucous membranes and sclera
  (dose dependent)
• Expansion of vascular volume
• Rate lt 10 ml/kg/hr

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What to Expect (Laboratory)

• Interference with some clinical chemistries
• No interference with CBC
• real increases in total protein, MCH, MCHC
• 10 -20 dilution of PCV with 30 ml/kg dosage
• PCV ? oxygen carrying capacity
• Urine discoloration (dose dependent)
• Interference with dipstick urinalysis

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Scleral Discoloration
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Valid Chemistries on Hitachi Analyzer with
Oxyglobin
Dose of 15 ml/kg
Dose of 30 ml/kg
Sodium Potassium Chloride Albumin CK Ca Glucose BU
N ALT AST Phosphorus Lipase Lactate Total
Bilirubin Bicarbonate TP ALP Magnesium
? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
? ? ? ? ? ? ? ? ? ? ?
? ? ? ? ? ? ? ?
Analytes
1.0
2.0
3.0
4.0
Plasma Oxyglobin Concentration (g/dL)
Roche Reagents
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How to Monitor Patients Receiving Oxyglobin
Solution

• Monitor clinical signs
• Heart rate and rhythm
• Respiratory rate and pattern
• Pulse quality
• Capillary refill time

• Body temperature
• Appetite
• Activity
• Urine production

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Oxyglobin Solution Practical Tips

• Do not exceed a rate of 10 mL/kg/hr in dogs
• For best results, store at room temperature
• May be warmed to 37ºC
• Do not warm in a microwave
• Compatible with all blood products
• Use within 24 hours of opening foil overwrap
• Collect chemistry samples prior to administration
• To avoid foaming, do not shake bag

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Features of Oxyglobin Solution

• Ready to use
• Standard IV set
• Any needle size
• No filter
• Any infusion pump
• Three year shelf life
• Room temperature
• Universal compatibility
• No need to type or crossmatch
• No transfusion - type reactions