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CPC-081 Management of Severe Anaemia with Recombinant Human Erythropoietin in a Jehovah’s Witness Patient: Case Report and Review of Literature
  1. J Giraud1,
  2. J Jezequel1,
  3. K Abdel Aal2,
  4. V Duperrin1,
  5. R Geha1,
  6. A Fabreguettes1
  1. 1CH Robert Ballanger, Pharmacy, Aulnay sous Bois, France
  2. 2CH Robert Ballanger, Cardiology, Aulnay Sous Bois, France

Abstract

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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