Management of severe anemia secondary to menorrhagia in a Jehovah's Witness: a case report and treatment algorithm

Severe anemia from heavy menstrual bleeding requires heightened attention

“…[31][32][33][34][35] Among 300,359 women in one large database who were hospitalized with gynecological conditions associated with heavy menstrual bleeding, more than 25% were diagnosed with anemia; nearly one quarter of these women were transfused. 36 Isolated case reports of severe anemia describe the considerable challenges in managing such patients, 37 but no recent studies have investigated the acute presentations and follow-ups of women with severe anemia because of heavy menstrual bleeding. The frequency with which women are treated for these problems at Harbor-UCLA Medical Center provided an opportunity to report detailed information about women with these problems in the 21st century.…”

Life-Threatening Pancreatitis in Jehovah’s Witness Patients With Severe Anemia Treated Without Transfusions and by Interventional Radiology Techniques

“…Thus, our experience with percutaneous IR procedures in these extremely ill JW patients mirrors that of the numerous clinical reports by other specialties, including orthopedic, cardiac, urologic, neurosurgical, gynecologic, and trauma reports, that despite severe anemia, patients can be managed successfully without blood transfusions. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] There are reports that restricting blood transfusions may even improve outcomes and reduce complications, compared to more liberal transfusion strategies. [17][18][19][20] Restricting blood transfusions using a hemoglobin trigger of <7 g/dL in patients with critical illnesses reduced cardiac events, rebleeding, bacterial infections, and total mortality.…”

“…Thus, our experience with percutaneous IR procedures in these extremely ill JW patients mirrors that of the numerous clinical reports by other specialties, including orthopedic, cardiac, urologic, neurosurgical, gynecologic, and trauma reports, that despite severe anemia, patients can be managed successfully without blood transfusions. 3 –16…”

“…2 The list of medical specialties with published reports of surgery or major procedures despite not accepting blood by JW patients who had severe anemia includes cardiac, [3][4][5] orthopedic, 6,7 urologic, 8,9 hepatic, 10 neurosurgical, 11 gynecologic, 12,13 liver transplant, 14 and obstetrics. 15,16 Our report describes 2 JW patients also with severe anemia and life-threatening pancreatitis who were treated successfully by various interventional radiology (IR) techniques. Thus, IR likely can be added to the list of medical and surgical specialties and subspecialties that have successfully treated major diseases without having blood products administered, despite severe anemia in JW patients.…”

Impact of Acute Normovolemic Hemodilution in Organ and Cell Structure

“…Except for few reports involving Jehovah's Witnesses patients (Gutierrez & Brotherton, 2011;Hashem & Dillard, 2004), data concerning use of exceedingly low hematocrit or hemoglobin thresholds derive from experimental studies. Such studies, performed with different species and various situations, demonstrated critical hematocrit levels between 10 and 15% (Fraga et al, 2005;Hiebl et al, 2010;van Bommel et al, 2002).…”