Profound Anaemia in a Jehovah's Witness following Upper Gastrointestinal Haemorrhage: Intensive Care Management

Abstract

Management of the profoundly anaemic patient who competently refuses blood transfusion will always prove challenging. This article provides a review of treatment strategies based around a recent case of a patient presenting after major gastrointestinal haemorrhage. The main part of management involves providing supportive intensive care, paying particular attention to oxygen delivery and consumption, and minimising further blood loss. Specific treatments, such as pharmacotherapy to promote erythropoiesis, are based largely on indirect evidence or expert opinion. Virtually all aspects of care involve carefully balancing a shifting profile of risks and benefits; a team approach and close communication with the family are essential. This patient's successful outcome has extended our understanding of this area, which is discussed.

Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion

“…In this study, we demonstrate that GIB patients can be successfully managed without the use of ABT when appropriate patient blood management methods are employed. This supports the results of previous cohort studies and case reports that demonstrate comparable mortality between patients with GIB that do and those that do not accept ABT [ 7 , 8 ]. Although our sample size is small, the mortality rate of 3.3% represents an acceptably low rate compared to previous reports [ 7 ].…”

“…between patients with GIB that do and those that do not accept ABT [7,8]. Although our sample size is small, the mortality rate of 3.3% represents an acceptably low rate compared to previous reports [7].…”