This article has been published with the written consent of the patient.
Postoperative management of severe acute anemia in a Jehovah's Witness
Article first published online: 9 OCT 2013
© 2013 American Association of Blood Banks
Volume 54, Issue 4, pages 1153–1157, April 2014
How to Cite
de Araújo Azi, L. M. T., Lopes, F. M. and Garcia, L. V. (2014), Postoperative management of severe acute anemia in a Jehovah's Witness. Transfusion, 54: 1153–1157. doi: 10.1111/trf.12424
- Issue published online: 11 APR 2014
- Article first published online: 9 OCT 2013
- Manuscript Accepted: 8 JUL 2013
- Manuscript Revised: 7 JUL 2013
- Manuscript Received: 17 JUN 2013
Low levels of hemoglobin (Hb) are not rare in patients who refuse blood components but this case is unique due to the severity of anemia and the possibility that her previous episode of acute normovolemic hemodilution has influenced her outcome.
We report an incident involving acute blood loss after surgery with an extremely low hematocrit. Despite her Hb levels (2.8 g/dL) she remained lucid, expressing her wish not to receive transfusion. When the patient lost consciousness (Hb, 1.4 g/dL) she was promptly sedated, curarized, and put onto mechanical controlled ventilation. Aggressive erythropoietin therapy increased the patient's Hb level by 240% in 10 days, despite a high platelet count. This case demonstrates that critical levels of oxygen delivery may be lower than previously thought possible.
This case is an example of the resilience of the human body in an extreme circumstance. It might be the most severe case of anemia that a person has survived without any sequelae.