Treatment of Severe Anemia in Jehovah’s Witness Patients

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  1. Epo 40,000 units IV daily until hemoglobin increases to at least 7 g/dL
  • Then decrease dose by 50% daily if continuing to improve
  • Ideally would like to see hemoglobin increase to 8 g/dL
  • Mortality in JH is very high if hemoglobin decreases to < 5 gm/dL
  1. Iron Sucrose 100 mg IV daily until hemoglobin is > 7 gm/dL
    • Re-evaluate at 10days, if still anemic, and still on ESA, continue IV iron therapy
  2. Minimize blood loss with daily ABG which is 1cc blood with Hbg/lytes (preferred for severe anemia) or alternatively with pediatric testing tubes
  3. Avoid hemodilution with crystalloid
    • Heplock IV and continue with PO diet only
    • Diuresis if fluid balance significantly positive to allow hem concentration
  4. If continued life-threatening anemia (hemoglobin <5g/dL or signs of critical anemia) consider transfusion of Hemopure (bovine hemoglobin substitute) on compassionate use basis with Emergency IND by FDA – Hemopure obtained from Investigational Drug Pharmacy for transfusion (not Blood Bank)

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  1. Title: Treatment of Severe Anemia in Jehovah’s Witness Patients
  2. Author:  Michigan Medicine
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  4. License: “CC BY-NC 4.0”

Treatment of Severe Anemia in Jehovah’s Witness Patients,  Michigan Medicine, Dept of Surgery,  “CC BY-NC 4.0”

Last reviewed: 09 June 2021