How do we treat life‐threatening anemia in a Jehovah's Witness patient?

Abstract

The refusal of allogeneic human blood and blood products by Jehovah's Witness (JW) patients complicates the treatment of life-threatening anemia. For JW patients, when hemoglobin (Hb) levels decrease beyond traditional transfusion thresholds (<7 g/dL), alternative methods to allogeneic blood transfusion can be utilized to augment erythropoiesis and restore endogenous Hb levels. The use of erythropoietin-stimulating agents and intravenous iron has been shown to restore red blood cell and Hb levels in JW patients, although these effects may be significantly delayed. When JW patients have evidence of life-threatening anemia (Hb <5 g/dL), oxygen-carrying capacity can be supplemented with the administration of Hb-based oxygen carriers (HBOCs). Although HBOCs are not Food and Drug Administration (FDA) approved, they may be obtained and administered with FDA, institutional review board, and patient approval. We describe a protocol-based algorithm to the management of life-threatening anemia in JW patients and review time to anemia reversal and patient outcomes using this approach.

Artificial Oxygen Carriers—Past, Present, and Future—a Review of the Most Innovative and Clinically Relevant Concepts

“…Sanguinate is available under an emergency investigational new drug protocol. Thus far, it has enabled survival of only a few patients refusing transfusion due to religious reasons (Posluszny and Napolitano, 2014;Abuchowski, 2016;Resar et al, 2016).…”

Difficult to swallow: warm autoimmune hemolytic anemia in a Jehovah's Witness treated with hemoglobin concentrate complicated by achalasia

“…For patients undergoing a planned surgical procedure, control of bleeding through surgical technique and intraoperative blood salvage is used to limit the need for blood transfusions. 18 Patients presenting with anemia severe enough to impair tissue oxygenation and resulting in the typical signs and symptoms of shock require more rapid resuscitation than that afforded by the measures discussed above, and treatment with HBOCs may be considered. However, among patients refusing allogeneic RBC transfusions, acceptance of HBOCs as an alternative should not be assumed to be universal.…”

Cardiovascular surgery in Jehovah's Witness patients: The role of preoperative optimization

“…Thus, we believe it is important to assist cardiac function to maximize oxygen delivery with inotrope or IABP support, and reduce oxygen consumption with mechanical ventilation support by minimizing the work of breathing. 21 Providing heart transplantation and LVAD implantation to Jehovah's Witnesses is an important, sensitive issue. We are extremely cautious when selecting these candidates.…”