Mortality risk stratification in severely anaemic Jehovah's Witness patients

Beliaev, Andrei M.; Marshall, Roger; Smith, Warren; Windsor, John A.

doi:10.1111/j.1445-5994.2011.02699.x

Cited by 20 publications

(18 citation statements)

References 10 publications

(15 reference statements)

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“…Previously, we have identified early mortality risk factors in severely anaemic JW patients, and proposed the Auckland AMRS. We have shown that the Auckland AMRS is associated with mortality of severely anaemic JW patients . With the development of the Hamilton AMRS, clinicians would be able to more closely monitor JW patients’ treatment progress.…”

Section: Discussionmentioning

confidence: 99%

“…In the published literature, there are few cohort studies that consider causes of mortality of severely anaemic JW patients in isolation and are lacking in their predictive power . Recently, we proposed a mortality risk stratification approach for severely anaemic JW patients based on a calculation of the Auckland Anaemia Mortality Risk Score . However, this method does not consider anaemia‐related complications that occur during patients’ treatment and cannot be used for mortality risk adjustment and treatment monitoring.…”

Section: Introductionmentioning

confidence: 99%

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Treatment monitoring and mortality risk adjustment in anaemic Jehovah's Witnesses

Beliaev

Marshall

Smith

et al. 2012

ANZ Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment monitoring and mortality risk adjustment in anaemic Jehovah's Witnesses

Beliaev

Marshall

Smith

et al. 2012

ANZ Journal of Surgery

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“…Early involvement of Hospital Liaison Committees for JWs may help in facilitating communication between the patients and the health care community. The Hamilton Anaemia Mortality Risk Score could aid in clinical decision making …”

Section: Discussionmentioning

confidence: 99%

Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma

et al. 2018

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Background Supportive care of Jehovah's Witnesses (JWs) diagnosed with cancer can be challenging, as they do not accept red blood cell (RBC) transfusions. Aim The study was designed to determine treatment preferences and pattern of care offered to JWs diagnosed with cancer and its impact on cancer management. Methods and results A retrospective cohort study of JWs with solid malignancies or lymphoma in our institution between 2005 and 2015 was conducted. Survival statistics were estimated using Kaplan Meier survival curves and Cox proportional regression model. A total of 63 JWs were identified with a median age of 70 years. At diagnosis, 34% (n = 22) had anaemia. All 63 declined RBC transfusion, including 19 patients who later developed transfusion threshold during anti‐cancer treatment. Forty‐three percent (n = 27) JWs had advanced (stage 4) disease, and 76% (n = 48) had Eastern Cooperative Oncology Group of 0 to 1. JWs were willing to accept surgery and radiation rather than chemotherapy. Treatment was deemed to be suboptimal in 22% (n = 14) JWs due to early treatment discontinuation, administration of non‐standard chemotherapy regimen, or dose reduction due to anaemia and denial of blood transfusion. Twenty‐seven percent (n = 17) received hematopoietic growth factors (erythropoiesis‐stimulating agents and pegfilgrastim). There was no mortality directly attributed to anaemia or refusal of blood transfusion in the entire cohort. Conclusion Jehovah's Witnesses declined RBC transfusion at diagnosis and during cancer therapy even if medically indicated. Management pathways need to be prospectively defined for this group of patients.

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“…A composite score of these risk factors stratifies mortality rates of 4% to 83% (AMRS 0-3, 4% mortality; AMRS 4-5, 32% mortality; AMRS 6-7, 50% mortality; AMRS ≥ 8, 83% mortality). 7 The Hamilton AMRS further refined their risk model by including treatmentrelated mortality risk factors during hospitalization (shock, acute gastrointestinal bleeding, pneumonia, nadir Hb ≤ 7 g/dL, sepsis, worse congestive heart failure, neurologic complications [stroke and hypoxic encephalopathy]). Higher Hamilton AMRS scores were associated with high mortality (0-2, 4% mortality; 3-4, 29%; 5, 40%; ≥6, 67%).…”

Section: Definition Of Severe Anemia and Mortality Riskmentioning

confidence: 99%

How do we treat life‐threatening anemia in a Jehovah's Witness patient?

Posluszny

Napolitano

2014

Transfusion

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The refusal of allogeneic human blood and blood products by Jehovah's Witness (JW) patients complicates the treatment of life-threatening anemia. For JW patients, when hemoglobin (Hb) levels decrease beyond traditional transfusion thresholds (<7 g/dL), alternative methods to allogeneic blood transfusion can be utilized to augment erythropoiesis and restore endogenous Hb levels. The use of erythropoietin-stimulating agents and intravenous iron has been shown to restore red blood cell and Hb levels in JW patients, although these effects may be significantly delayed. When JW patients have evidence of life-threatening anemia (Hb <5 g/dL), oxygen-carrying capacity can be supplemented with the administration of Hb-based oxygen carriers (HBOCs). Although HBOCs are not Food and Drug Administration (FDA) approved, they may be obtained and administered with FDA, institutional review board, and patient approval. We describe a protocol-based algorithm to the management of life-threatening anemia in JW patients and review time to anemia reversal and patient outcomes using this approach.

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Mortality risk stratification in severely anaemic Jehovah's Witness patients

Cited by 20 publications

References 10 publications

Treatment monitoring and mortality risk adjustment in anaemic Jehovah's Witnesses

Treatment monitoring and mortality risk adjustment in anaemic Jehovah's Witnesses

Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma

How do we treat life‐threatening anemia in a Jehovah's Witness patient?

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