Managing severe anemia when the patient is a Jehovah's Witness
¦ Severe anemia in a patient who will not accept blood products presents a significant challenge for the health care team. As health care providers, we must be aware of these patients' wishes and have plans in place to provide care from the time of admission to the day of discharge.
¦ Jehovah's Witnesses will refuse all major blood fractions, including whole blood, packed RBCs, plasma, and platelets. Minor fractions are allowed and the decision to accept or refuse these fractions is a personal one made by each Witness.
¦ The goals of anemia management include cessation of blood loss, meticulous conservation of blood, optimizing hematopoiesis, and assessing the patient's physiologic tolerance of anemia.
¦ Profound anemia with a hemoglobin level of 2.6 g/dL is survivable without a blood transfusion.
¦ A conservative dosing regimen of erythropoiesis-stimulating agents can be effective in increasing the hemoglobin level of severely anemic patients.