Recombinant human erythropoietin therapy in critically ill Jehovah's Witnesses
ABSTRACT 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.
- SourceAvailable from: Manjunath Pai
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- "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. "
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 · 1.31 Impact Factor
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ABSTRACT: PurposeCertain patients may be unwilling to accept blood products for religious reasons. In this study, we have assessed the clinical cancer treatment outcomes of Jehovah’s Witnesses (JW) cancer patients in order to identify the risks associated with their treatment, as well as their transfusion needs. MethodsWe analyzed 77 cases of histologically confirmed cancer patients (JW) from January 2001 to April 2008. ResultsThe median age of the patients was 59years (range, 8–83years). The most common primary site was the stomach (20.8%), followed by the breast (14.3%), and colorectal region (11.7%). Operations were performed on 44 patients (89.8%). Changes in complete blood count profiles after operation were detected in the patients’ hemoglobin (mean ± SD; 12.7 ± 2.1g/dL to 10.6 ± 2.3g/dL, P < 0.001). Twenty-six patients received adjuvant chemotherapy. Among these, 21 (80.8%) completed their planned schedule. One hundred twenty-seven cycles of palliative intravenous chemotherapy were administered to 19 patients. Granulocyte-colony stimulating factor and erythropoietin were used in 45 and 20 cycles of treatment, respectively. Grade ≥III thrombocytopenia and anemia were noted in 3.9% and 2.4% of the patients. Three- and 5-year survival rates were 80% and 70%, respectively. The most frequent cause of death was disease progression rather than bleeding. ConclusionsBloodless cancer operation and chemotherapy were not accompanied by serious complications. A few cases of palliative chemotherapy also required transfusions. A prospective cohort study group will need to be used to determine precisely the safety of bloodless cancer treatment and the efficacy of transfusion alternatives. KeywordsBloodless-Cancer-Operation-ChemotherapySupportive Care Cancer 01/2010; 18(10):1341-1346. DOI:10.1007/s00520-009-0759-3 · 2.50 Impact Factor
- Value in Health 11/2002; 5(6):571-571. DOI:10.1016/S1098-3015(10)61503-3 · 2.89 Impact Factor