Treatment monitoring and mortality risk adjustment in anaemic <scp>J</scp>ehovah's <scp>W</scp>itnesses

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

doi:10.1111/j.1445-2197.2012.06228.x

Cited by 12 publications

(7 citation statements)

References 10 publications

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“… 8 , 9 Included among these is the Hamilton Anemia Mortality Risk Score, which has been shown to be of value in assessing risk among Jehovah's Witness patients in particular. 10 Had the Hamilton Anemia Mortality Risk Score been calculated preoperatively, our patient's score would have fallen into the lowest range of the index, indicating an absolute mortality risk of only 4% and lending support to an aggressive treatment approach. The benefits of BKA over AKA for this patient were obvious, 11 perhaps the most notable being the significant savings in ambulation-associated energy expenditure that is achieved with a BKA prosthesis.…”

Section: Discussionmentioning

confidence: 74%

Thrombolytic therapy for critical limb ischemia in a Jehovah's Witness with severe anemia

Kauffman

Watson

Campbell

2017

Journal of Vascular Surgery Cases, Innovations and Techniques

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A patient's refusal to receive blood products can pose both clinical and ethical challenges to the surgeon. In this report, we review the case of a Jehovah's Witness presenting with critical lower limb ischemia and severe anemia for whom the decision of whether to perform thrombolytic therapy was complicated by his refusal to accept blood products. The case demonstrates that thrombolytic therapy can produce favorable results in severely anemic patients even when transfusion is not an option. We conclude that offering thrombolytic therapy in this context is a reasonable therapeutic option from both a clinical and ethical perspective.

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Section: Discussionmentioning

confidence: 74%

Thrombolytic therapy for critical limb ischemia in a Jehovah's Witness with severe anemia

Kauffman

Watson

Campbell

2017

Journal of Vascular Surgery Cases, Innovations and Techniques

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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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“…Higher Hamilton AMRS scores were associated with high mortality (0-2, 4% mortality; 3-4, 29%; 5, 40%; ≥6, 67%). 8 Although these risk assessment scores have not yet been validated in large multicenter studies, they promote the fact that there are high mortality rates associated with anemia in JW patients.…”

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

Abstract: The Hamilton AMRS allows treatment monitoring of anaemic JW patients and adjustment of their risk of mortality.

Cited by 12 publications

References 10 publications

Thrombolytic therapy for critical limb ischemia in a Jehovah's Witness with severe anemia

Thrombolytic therapy for critical limb ischemia in a Jehovah's Witness with severe anemia

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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