Postoperative management of severe acute anemia in a Jehovah's Witness

Transfusion. 2014 Apr;54(4):1153-7. doi: 10.1111/trf.12424. Epub 2013 Oct 9.


Background: Low levels of hemoglobin (Hb) are not rare in patients who refuse blood components but this case is unique due to the severity of anemia and the possibility that her previous episode of acute normovolemic hemodilution has influenced her outcome.

Case report: We report an incident involving acute blood loss after surgery with an extremely low hematocrit. Despite her Hb levels (2.8 g/dL) she remained lucid, expressing her wish not to receive transfusion. When the patient lost consciousness (Hb, 1.4 g/dL) she was promptly sedated, curarized, and put onto mechanical controlled ventilation. Aggressive erythropoietin therapy increased the patient's Hb level by 240% in 10 days, despite a high platelet count. This case demonstrates that critical levels of oxygen delivery may be lower than previously thought possible.

Conclusion: This case is an example of the resilience of the human body in an extreme circumstance. It might be the most severe case of anemia that a person has survived without any sequelae.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Anemia / etiology
  • Anemia / therapy*
  • Blood Transfusion / psychology
  • Erythropoietin / therapeutic use
  • Female
  • Humans
  • Jehovah's Witnesses*
  • Postoperative Hemorrhage / complications*
  • Postoperative Hemorrhage / therapy*
  • Respiration, Artificial
  • Severity of Illness Index
  • Treatment Refusal


  • Erythropoietin