Hyperbaric oxygen therapy to promote wound healing in severe pancytopenia: a case report

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OBJECTIVE: Wound healing fundamentally requires an intact haematologic profile, and an adequate number and function of leukocytes, erythrocytes and platelets is a precondition for quelling infection and remodelling damaged tissue. Hyperbaric oxygen therapy (HBOT) is an adjunctive management for chronic and complex wounds and, unlike many classical elements of multidisciplinary wound care, its effects are not wholly mediated by these cell lineages. HBOT is known to enhance oxygen delivery to tissues, and support microvascular growth, to facilitate wound healing. HBOT also promotes the mobilisation of endogenous stem cells; however, its use in combination with bone marrow transplantation to augment engraftment is controversial. METHOD: We describe a case report in which HBOT was successfully applied as part of ongoing adjuvant treatment for a complex sacral wound, in the context of myelodysplastic syndrome and aplastic anaemia, to facilitate allogenic bone marrow transplantation and subsequent recovery. RESULTS: After ongoing wound deterioration despite conventional therapy and wound care, the patient underwent a total of 49 sessions of HBOT at a pressure of 2.0 atmosphere absolutes, each for 90 minutes (including two air breaks). Allogenic stem cell transplantation was performed after the ninth treatment. The patient's complex sacral wound demonstrated markedly increased granulation in the early phase of HBOT, and after concurrent bone marrow transplantation it resolved completely by secondary intention. More than one year later it remained completely healed, and repeat bone marrow biopsy demonstrated a normocellular aspirate with stable circulating cell counts. CONCLUSION: Our report describes the novel advantages of HBOT over other conventional wound therapies in the context of severe haematologic compromise and supports its potential for synergy with bone marrow transplantation.

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