Background The medical care of Jehovah’s Witness patients, because they refuse blood transfusion, becomes problematic in cases of severe life-threatening anaemia.
Purpose To describe the case of a patient with severe anaemia who received erythropoietin (EPO) treatment as the result of a literature review.
Materials and Methods A 77-year old woman was sent to the emergency department with thoracoepigastric pain, blood clots and vomiting for a week. Cardiac examination revealed a coronary syndrome caused by gastrointestinally-induced anaemia at 5.6 g/dl (haematocrit = 18.9%). On day 3 the haemoglobin fell to 4 g/dl (haematocrit = 14.4%) upon which a treatment with EPO beta at 30,000 IU per week (380 IU/kg/week) associated with high intravenous iron supplementation (300 mg/48 hours) was instituted. After 16 days of treatment haemoglobin (8.9 g/dl) and haematocrit (31.6%) had doubled and clinical improvement was observed. The patient was discharged on day 22 of treatment with a total of 4 EPO injections (haemoglobin = 9.6 g/dl).
Results Currently in emergency there is no alternative to transfusion and a higher mortality is linked to a low haemoglobin level. In a multicentre study with 148 patients, Georgopoulos et al, showed the efficacy of EPO, used off-label, administered once weekly, to reduce transfusions.
Thirteen recent publications reported experiences with the intravenous or subcutaneous administration of EPO in anaemia treatment. The optimal dose of EPO remains unclear: dosage ranges from 200 μg/week darbepoetin alfa (Gutierrez et al), to 130 IU/kg of EPO three times weekly (Walton et al), to 600 Iu/kg/day for 2 days to 300 IU/kg/day (Cothren et al). After starting treatment the haemoglobin level doubled in 19 days (in an average of 4 days–30 days).
Conclusions Our weekly EPO protocol is in the lower targets found in the literature but it appears as effective as other protocols. Significant variability without a major difference in efficacy appears when EPO is used for Jehovah’s Witness patients, but EPO may provide an alternative treatment in life-threatening anaemia, when blood transfusions are not accepted.
No conflict of interest.
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