How Can Hyperbaric Oxygen Therapy Benefit the Bloodless Patient?
An Interview of Mark Lega, M.D.
Dr. Lega is a Pulmonologist and Critical Care Specialist at Allegheny General Hospital.
Walking into the Hyperbaric Medicine Unit at Allegheny General Hospital I observe a large room with two clear acrylic cylinder-shaped enclosures. Staff including Critical Care physicians, nurses and respiratory-therapists attend to the patients. One patient is watching TV through the clear chamber while receiving his treatment. Between four and eight persons are treated daily in these chambers.
Bloodless Medicine: What is Hyperbaric Oxygen Therapy?
Dr. Lega: Hyperbaric Oxygen Therapy is a way of delivering an increased concentration of oxygen to people. A person breathing room air will have an oxygen concentration level of about 80 pO2. After a treatment with hyperbaric oxygen, this may increase to a level has high as 2000 pO2.
Bloodless Medicine: How is this done?
Dr. Lega: The patient slides into the hyperbaric oxygen chamber, lying on his back. The door is sealed and pressure is gradually increased until a pressure equivalent to 2 to 3 atmospheres is reached. This does not hurt. A sensation of fullness in the ears similar to flying in an airplane may be experienced. It takes from between 6 and 10 hours for the increased oxygen level to be washed from the body after treatment. An average treatment may last for about 90 minutes. As many as two or three treatments may be performed each day.
Bloodless Medicine: Why is oxygen level in the body important? How does this relate to blood?
Dr. Lega: Oxygen fuels the body’s cells and processes. Oxygen is carried in the bloodstream by red blood cells. When the number of red cells in the body is significantly decreased (low blood count) this is called anemia. Because the amount of oxygen that can be carried by each red blood cell is finite, the severely anemic patient in turn will have severely decreased oxygen carrying capacity. This decreased oxygen level may in turn cause acute injury such as a heart attack.
Bloodless Medicine: If the problem is low red blood cell count, how can hyperbaric oxygen therapy help?
Dr. Lega: Hyperbaric oxygen therapy delivers oxygen to the blood in a different way. It does this by dissolving oxygen into the patient’s blood plasma. The amount of oxygen dissolved in blood plasma is usually negligible, but after hyperbaric oxygen therapy this is significantly increased. Thus this therapy can provide a bridge for a patient, allowing adequate oxygenation while waiting for the body to produce more red cells.
Bloodless Medicine: What can be done to stimulate the body’s production of red cells?
Dr. Lega: A combination of therapies including recombinant erythropoietin, iron and other nutrients can spur the production of red cells. Of course, aggressive efforts to stop any bleeding and restricting phlebotomy are also needed. Our team in Critical Care medicine have gained much valuable experience in these methods while treating patients who come to us through the Bloodless Medicine program.
Bloodless Medicine: Is Hyperbaric Oxygen therapy a commonly available option for patients?
Dr. Lega: No. Only very specialized centers will have
this available. Most hospitals do not. This availability of technology as
well as knowledge of Bloodless Medicine and Surgery techniques that we have
at Allegheny General Hospital really makes us a preferred provider for patients
such as Jehovah’s Witnesses. While we have used this therapy for Bloodless
patients, most patients will not require it. It should be of comfort to
patients who cannot accept transfusions to know that at our hospital not
only do we have Coordinators who will advocate for them, but the clinical
knowledge and tools such as hyper baric oxygen therapy which can be available
and used in extreme situations, if needed.
