Pharmacotherapy in Acutely Anemic Jehovah’s Witnesses: An Evidence-Based Review

Abstract

There are currently not enough data to make definitive recommendations on the use of pharmacological agents to treat severe anemia in the JW population. Further evidence utilizing EPO and HBOCs will be beneficial to guide therapy.

Artificial Oxygen Carriers—Past, Present, and Future—a Review of the Most Innovative and Clinically Relevant Concepts

“…Severely anemic patients refusing transfusion on religious grounds can benefit from AOCs. However, to date, there are just single case reports and not enough evidence to generally advise their use in combination with standard care (McConachie et al, 2018). To this end, some products have reached clinical use in selected countries.…”

Early Experiences With PEGylated Carboxyhemoglobin Bovine in Anemic Jehovah’s Witnesses: A Case Series and Review of the Literature

“…7 Although there are alternative methods to reduce oxygen consumption and increase blood oxygenation, [17][18][19] HBOCs represent the only available pharmacotherapy capable of rapidly increasing oxygen-carrying capacity of JW patients in practice. 6 Despite their potential to improve tissue oxygenation, HBOCS are associated with risks as well. 8,15 Previous analyses linked HBOCs to numerous adverse events including arrhythmias, renal injury, and transient hypertension.…”

“…2,3,18 HBOCs should be administered in conjunction with other medications including IV iron and EPO to raise endogenous hgb levels as quickly as possible. 3,5,6,30 The optimal dose of EPO is currently unknown. 7,31,32 However, the majority of case reports demonstrating good clinical outcomes used high-dose EPO in the range of 300 to 600 units/kg/d.…”

“…The adjunctive use of vitamin B 12 , folate, and vitamin C is also recommended to stimulate hematopoiesis and to facilitate iron incorporation into the heme molecule. 3,5,6,30 However, our case series, like all descriptive analyses, is limited by the diverse patients represented and the nonsystematic nature of the study.…”

“…Commonly used medical approaches include stimulating endogenous hematopoiesis through the use of intravenous (IV) iron and high-dose EPO alfa, preserving patients' endogenous hemoglobin (hgb), and promoting hemostasis. [1][2][3][4][5][6] Unfortunately, bone marrow response to exogenous EPO is characteristically slow and maximal reticulocytosis may not be reached until day 15 in critically ill patients. 7 This is problematic for critically anemic patients because there are currently no Food and Drug Administration (FDA)-approved treatments that can acutely improve a patient's oxygen-carrying capacity.…”