Treatment of a Jehovah's Witness using a transfusion-free autologous stem cell transplant protocol

Brown, Nicole M.; Matthews, Barbara; Ford, Patricia

doi:10.1016/s1548-5315(11)70948-2

Cited by 9 publications

(14 citation statements)

References 17 publications

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“…Using this approach, Brown et al [65] reported on a series of 48 Jehovah's Witness patients with hematologic malignancies treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation (APBSCT) without any allogeneic transfusion with "acceptable morbidity and mortality." There were two deaths (4.17% mortality), of which only one was related to withholding transfusion.…”

Section: Discussionmentioning

confidence: 99%

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

2011

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The objective of this paper is to introduce clinicians and health care professionals to the concept of patient blood management (PBM) and to explain the difference between PBM and the concept of "appropriate use" of blood products. The five reasons why modern health systems need to shift from product-focused transfusion practice to PBM are also presented. These are: the aging population with a leveraged demand for blood products opposed to a shrinking donor base; the growing awareness that transfusion is a complex service involving many different cost centers within a hospital and representing a multiple of the blood product cost; the continuous effort to protect blood pools from known, new, or re-emerging pathogens while facing uncertainty over their potentially long silent carrier states; the emerging evidence that transfusion is an independent risk factor for adverse outcomes; and finally, a lack of evidence for benefit of transfusion for the vast majority of recipients. The Oncologist 2011;16(suppl 3):3-11

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Section: Discussionmentioning

confidence: 99%

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

2011

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“…The two largest series reported a transplant mortality of below 10%. Ford and co-workers 20 at the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital have performed the largest number of bloodless transplants and published their findings. The most illustrative series, reported by Ballen et al, 19 describes the outcomes of 26 patients undergoing Auto-SCT without the use of blood products.…”

Section: Autologous Transplantation In Jehovah's Witnessesmentioning

confidence: 99%

“…Some authors advocate for daily cryoprecipitate even in the absence of hypofibrinogenemia, although this practice is not evidence-based. 20 When the PT or PTT are prolonged, the deficient factor(s) should be identified and replaced to the extent possible. The etiology underlying the factor deficiency must be corrected.…”

Section: Treatment and Prevention Of Bleeding In Thrombocytopenic Patmentioning

confidence: 99%

“…Although aprotinin has the most evidence supporting its use, it has recently been taken off the market, and it appears that Amicar and tranexamic acid are at least as effective as aprotinin. 70 The published case series have started Amicar when the platelet count was below 30 Â 10 9 /l; doses were adjusted upwards for bleeding 19,20 (see Table 2). Although generally very safe, Amicar should be used with extreme caution for patients with urinary bleeding or disseminated intravascular coagulation; doses must be adjusted for renal insufficiency.…”

Section: Treatment and Prevention Of Bleeding In Thrombocytopenic Patmentioning

confidence: 99%

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SCT in Jehovah's Witnesses: the bloodless transplant

Sloan

Ballen

2008

Bone Marrow Transplant

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“…We treated our first JW with a bloodless autologous stem cell transplant successfully 9 years ago. We have completed the largest published series of bloodless ASCT, with only two mortalities related to profound anemia of the sixty patients [2]. To support our patients during pancytopenia, we have derived a bloodless schema aimed at supporting patients through severe anemia and thrombocytopenia (see Figure 1).…”

mentioning

confidence: 99%

Acute myeloid leukemia in Jehovah Witnesses

Brown

Keck

Ford

2008

Leukemia & Lymphoma

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Many physicians refuse to treat Jehovah Witnesses (JW) with acute myeloid leukemia (AML) for fear of treatment related death. Treatment generally necessitates transfusion support due to severe and prolonged pancytopenia caused by standard induction and consolidation chemotherapy regimens. Because JW will not accept blood products, these patients are being denied treatment.Treating a JW with acute lymphoblastic leukemia (ALL) or acute promyelocytic leukemia (APL) incurs much less risk than treating those with AML. ALL and APL are very sensitive to non-myelosuppressive drugs, therefore treatment can be initiated with vincristine and prednisone with or without Lasparaginase or all-trans retinoic acid respectively until blood counts have recovered and standard therapy can proceed. For this reason, we will be focusing on the treatment of JW with AML.Standard treatment of AML begins with remission induction chemotherapy aimed at the rapid eradication of acute leukemic clones. Induction chemotherapy usually consists of cytarabine 100 mg/m 2 /day on days 1-7 and either idarubicin 12 mg/m 2 /day or daunorubicin 45 mg/m 2 /day on days 1-3. A patient is considered to be in complete remission when peripheral blood counts return to normal and there are less than 5% blasts in the bone marrow with none of the leukemic phenotype. It is known that there are still residual, undetected leukemic cells that result in a relapse if further consolidation therapy is not administered. A patient's cytogenetics and other prognostic factors determines the form of consolidation therapy, which could be 2-4 cycles of cytarabine or an allogeneic hematopoietic stem cell transplant. During the first cycle of induction chemotherapy, patients with AML are given an average of 10.8 red blood cell transfusions and 8.5 platelet transfusions during a period of about 30 days [1] leading physicians to believe that a JW could not survive treatment without the ability to transfuse.In the literature, only 21 cases have been reported on the treatment of AML in JW. Here we report our experience treating JW without blood followed by a brief literature review to demonstrate the ability and relative success in treating these patients.JW believe that once blood has been removed from the body, it should be disposed of and not returned. This proscription applies to red and white blood cells, platelets and plasma. However, the decision to accept minor blood fractions (albumin, cryoprecipitate, clotting factors), organs and stem cells are up to the individual congregant.Until recently, JW patients were not being offered bloodless autologous stem cell transplants (ASCT) for fear that they could not survive treatment. We treated our first JW with a bloodless autologous stem cell transplant successfully 9 years ago. We have completed the largest published series of bloodless ASCT, with only two mortalities related to profound anemia of the sixty patients [2]. To support our patients during pancytopenia, we have derived a bloodless schema aimed at supporting patients throu...

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Treatment of a Jehovah's Witness using a transfusion-free autologous stem cell transplant protocol

Cited by 9 publications

References 17 publications

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

SCT in Jehovah's Witnesses: the bloodless transplant

Acute myeloid leukemia in Jehovah Witnesses

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