Recombinant Human Erythropoietin Therapy in Critically Ill Jehovah's Witnesses
Department of Pharmacy, the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. Pharmacotherapy
(Impact Factor: 2.66).
12/2008; 28(11):1383-90. DOI: 10.1592/phco.28.11.1383
Blood transfusions and blood products are often given as a life-saving measure in patients with critical illness. However, some patients, such as Jehovah's Witnesses, may refuse their administration due to religious beliefs. Jehovah's Witnesses accept most available medical treatments, but not blood transfusions or blood products due to their religion's interpretation of several passages from the Bible. Since recombinant human erythropoietin (rHuEPO) became available, several cases have been reported in which rHuEPO was successfully administered to critically ill Jehovah's Witnesses. Administration of rHuEPO in combination with other blood conservation techniques has been shown to increase hemoglobin levels and survival in patients who experienced trauma, burns, general surgery, or gastrointestinal hemorrhage. We performed a literature search of the MEDLINE and International Pharmaceutical Abstracts databases of rHuEPO therapy in the Jehovah's Witness population. Fourteen cases were identified in which rHuEPO was administered to Jehovah's Witnesses who required the drug for critical care resuscitation as an alternative to blood products. In each clinical situation, rHuEPO enhanced erythropoiesis; however, time to the start of treatment, dosages, route of administration, and treatment duration varied widely. Supplementation with adjunctive agents, such as iron, folic acid, and vitamin B12, was also beneficial. Use of rHuEPO in Jehovah's Witnesses may provide an alternative to blood transfusions or blood products. Other alternatives, such as hemoglobin-based oxygen carriers and perfluorocarbons, are also being explored.
Available from: Manjunath Pai
- "In contrast, many published case reports of untransfusable patients attributed rapid Hgb recovery, at least in part, to the use of EPO. These case reports are often cited in articles recommending use of EPO, sometimes at very high doses (Charles et al., 2006; Ball & Winstead, 2008; Melmed et al., 2009; Beliaev, 2013). The decision to use EPO therapy should be based on a thorough risk–benefit assessment including a quantitative understanding of the size of potential treatment effects. "
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ABSTRACT: Background:Erythropoiesis stimulating agents [erythropoietin (EPO)] have been recommended to treat anaemic patients who cannot receive or refuse blood tranfusion (‘untransfusable’ patients).Objective:The objective of the study was to quantify the association of EPO use with haemoglobin (Hgb) recovery in anaemic untransfusable hospitalised patients.Methods/materials:EPO treated anaemic untransfusable patients were identified through the combination of a retrospective case review and a systematic review of the medical literature. Literature reports of untransfusable patients not treated with any EPO were used as a comparator group. Hgb concentrations before and following EPO use were abstracted and used to determine the rate of Hgb recovery for each case. Multilevel mixed effects modelling was used to determine the association of Hgb recovery with EPO use.Results:A total of 76 EPO treated cases (19 cases from the retrospective hospital case review and 57 from the literature), and 33 non-EPO treated comparator patients from the literature were included in the study. Hgb increased similarly over time in all groups at an overall mean standard error (SE) rate of 0·13 (0·01) g dL−1 day−1. The Hgb recovery rate was higher in patients with lower baseline Hgb, regardless of EPO use. No association was found between the rate of Hgb recovery and EPO use, dose or therapy duration.Conclusions:In anaemic, ‘untransfusable’ hospitalised patients, EPO use was not associated with increased Hgb recovery at anytime within 28 days.
Transfusion Medicine 04/2014; 24(4). DOI:10.1111/tme.12120 · 1.65 Impact Factor
Available from: sciencedirect.com
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