Hematological support of patients with significant anemia who decline red blood cell blood transfusion

Abstract

Patients who decline blood transfusion either due to religious or personal objections pose challenges in the face of potentially lifethreatening acute anemia. Decreases in hemoglobin are associated with increased mortality risk in patients who decline blood transfusion in the perioperative setting. 1 Therefore, implementation of now wellestablished preoperative protocols for this unique patient population involves varying doses of erythropoiesis-stimulating agents (ESA) and supplementation with iron, folate, and/or vitamin B12. Large studies involving preoperative cardiac surgery patients who decline blood transfusion have shown acceptable surgical outcomes. 2However, in real-world settings, severe anemia may arise in either