Professor Lee Jae-Myeong of Korea University Anam Hospital successfully treats a patient with the lowest hemoglobin level in the world without a transfusion

A medical team in Korea succeeded in treating a trauma patient who recorded the lowest hemoglobin level in the world without a blood transfusion.

According to Korea University Anam Hospital on the 10th, Professor Lee Jae-Myeong in the Intensive Care and Trauma Surgery Department successfully performed transfusion-free surgery on a patient in his 70s with a hemoglobin level of 2.5 g/dL.

Patient A (a 71-year-old male) displayed various symptoms such as bleeding, breathing difficulty and severe anemia due to fractures of various body parts including bilateral ribs and left pelvic bone caused by being caught in a landslide, and had a hemoglobin level of 2.5 g/dL, the lowest level in the world. The lowest hemoglobin level previously reported in a patient in the past 20 years was 2.7 g/dL

In addition, the hemoglobin level of the patient hospitalized for severe post-traumatic blood loss was 3.9 g/dL on the fourth day of hospitalization, which is far below the normal range of 13-16 g/dL. If the levels of oxygen-carrying hemoglobin in the blood are low, disorders such as myocardial infarction, arrhythmia, etc. can be induced, and the mortality rate is as high as 34.4% if this level is below 5 g/dL, and requires quick transfusion as an essential measure.

However, the patient refused blood transfusion due to his religious beliefs and Professor Lee, respecting the patient's wish, implemented an alternative treatment strategy. According to the hospital, although the patient's hemoglobin level recovered to 7.4 g/dL after 16 days of supportive care, there was an emergency situation where the hemoglobin level dropped to 2.5 g/dL on the 41st day of hospitalization due to a stressful hemorrhagic gastric ulcer.

Accordingly, Prof. Lee performed endoscopic hemostasis to make sure that there was no waste of blood by conducting blood tests only when absolutely necessary due to concerns about blood loss from blood collection.

Since the patient's hypotension persisted despite the successful completion of the surgery, the team systematically managed the patient with the goals of strengthening the coagulation system and minimizing the loss and increasing the production of erythrocyte. As a result, the patient's condition improved and his hemoglobin level was normalized to 14.1 g/dL on the 56th day of hospitalization.

Prof. Lee said, "For blood transfusion-free treatment, it is important for the medical staff to make prudent decisions based on their extensive experience and data at each stage of patient care including clear identification and quick control of the site of bleeding, and administration of the right dose of medication according to the patient's condition."

He added that, "Although it is difficult to treat trauma patients without blood transfusions, I believe it is an important role of medical staff to respect patients' beliefs and provide the best medical practices required. Blood transfusion-free treatment is becoming a new hope for patients who do not want to receive blood transfusions according to their personal beliefs or who cannot receive them for various physical reasons such as transfusion side effects, etc."

Korea University Anam Hospital is the first minimal blood transfusion surgery hospital in Asia and aims to minimize blood transfusions throughout the hospital, and is implementing systematic patient blood management. It has established a structured treatment system by developing a minimum blood transfusion algorithm through accumulated big data related to patient blood management.

Professor Lee Jae-Myeong is leading the culture of minimal blood transfusion by respecting the choices of patients and establishing an even safer process by pursuing research on an automated system for blood collection and preservation to minimize blood being wasted due to collection.

The case was published in the American Journal of Case Reports, an SCI-ranked international journal, and drew the attention of the academic community.