In their excellent review of the management of the severely anemic Jehovah's Witness patient, Mann and colleagues [1] inaccurately report that "the use of adjunctive hyperbaric oxygen therapy is not indicated in the management of anemic Jehovah's Witnesses because toxicity precludes its prolonged use." This conflicts with reports supporting the use of such therapy in anemic patients with severe blood loss who are unable, either on medical or religious grounds, to receive blood products. Amonic and colleagues [2] first reported the successful use of hyperbaric oxygen therapy in hemorrhagic shock in 1969. Hart and colleagues [3] recently reviewed 26 anemic patients with exceptionally severe blood loss and class IV shock, reporting an overall survival of 70% using adjunctive hyperbaric oxygen therapy. Therapy was well tolerated and oxygen toxicity was not reported. Use of adjunctive hyperbaric oxygen therapy is endorsed by the Undersea and Hyperbaric Medical Society Committee [4], which periodically reviews and approves clinical applications of adjunctive hyperbaric oxygen therapy.

In six anemic patients with severe blood loss and shock, we found hyperbaric oxygen therapy to be beneficial and not to be required continuously. Hyperbaric oxygen therapy substantially enhances tissue oxygen delivery, reverses tissue oxygen debt, and saturates tissues with a high partial pressure of oxygen. At 66 feet of sea water or 3 atmospheres absolute, the plasma oxygen-carrying capacity alone is greater than 6 volumes percent, exceeding the normal arterial to venous oxygen extraction. Clinically, the effect of hyperbaric oxygen treatment exceeds the treatment time by using saturated tissue reserves. Treatment frequency depends on patient response and is usually tapered over days until the patient is stable. We believe that adjunctive hyperbaric oxygen therapy may have reduced the prolonged and complicated course the patient experienced by enhancing tissue oxygen delivery during the acute phase. Only through a good understanding of religious tenets, available therapy, and medicolegal issues can physicians appropriately manage these patients.