Use of erythropoietin in a pregnant Jehovah's Witness with sickle-cell disease

Abstract

1999). There is a significantly increased prevalence of tinnitus in pregnant women compared with a similar non-pregnant group (Gurr et al. 1993).There are several speculations why tinnitus occurs in pregnancy. Hyperdynamic circulation, increase in perilymphatic fluid pressure and hormonal changes have been suggested (Preece et al. 1975).Tinnitus could be a warning sign of early pre-eclampsia (Shapiro et al. 1999). A rise in intracranial pressure (resulting from pre-eclampsia) can be transmitted to the perilymphatic fluid through the cochlear duct.We did a Medline search from 1966 to 2005, searching for cases of severe tinnitus in pregnancy, necessitating a caesarean delivery. No case has been reported so far.In this case, normal findings at otoscopy ruled out local pathology as a cause of tinnitus. A normal CT brain scan excluded temporal lobe lesions and glomus tumours of the internal ear. A normal carotid artery ultrasound ruled out a carotid body tumour. Our patient did not have any affective disorder (as is present in 40% of cases with tinnitus) or pre-eclampsia.With all major causes ruled out, we believe that the severe tinnitus was attributable to the pregnancy. We agree with other authors that tinnitus is common in pregnancy, and that complete resolution occurs once pregnancy is over. The uniqueness of our case lies in its severity, i.e. so severe that caesarean delivery was needed. We present this case as an unusual manifestation in pregnancy.

Peripartum hyperhemolysis prophylaxis and management in sickle cell disease: A case report and narrative review

“…To ameliorate the potential anemia induced by HU, ESAs were considered. There was only one previous published report of EPO beta used in a pregnant SCD patient who was also a Jehovah's Witness and could not be transfused 27 . Her Hb was managed through pregnancy with ESAs and IV iron.…”

“…There was only one previous published report of EPO beta used in a pregnant SCD patient who was also a Jehovah's Witness and could not be transfused. 27 Her Hb was managed through pregnancy with ESAs and IV iron. The pregnancy was successful, and the baby was small for gestational age.…”

“…The infant did have low birthweight at delivery, similar to the case published by Tan and colleaguse. 27…”

Management of women who decline blood and blood products in pregnancy

“…'s 14 observational study of Jehovah's Witnesses in the USA, all 166 women with low haematocrit at 28 weeks were offered erythropoietin but the 6 (4%) who accepted had a nonsignificant rise in haematocrit compared with those who declined. Erythropoietin cannot yet be recommended outside clinical trials because of limited data, but there are case reports describing its use in high‐risk Jehovah's Witness patients 25 …”

A Young Adult Jehovah’s Witness With Severe Anemia

“…Erythropoietin has been shown to increase red cell production within days to weeks of use. 15 A combination of erythropoietin, iron supplementation, and hydroxyurea has been shown to increase fetal hemoglobin and ameliorate sickling crises. 16 Early aggressive intervention with these agents can sometimes prevent significant anemia and the ensuing complications.…”