Long-lasting extreme anemia during the therapy of acute lymphoblastic leukemia in a Jehovah's Witness patient

Transfusion. 2016 Oct;56(10):2438-2442. doi: 10.1111/trf.13703. Epub 2016 Jul 7.

Abstract

Background: The treatment of patients with acute leukemia, who due to their religious beliefs refuse to accept blood transfusion, is a great challenge for hematologists.

Case report: We present a case of acute pre-T-lymphoblastic leukemia in a Jehovah's Witness who did not accept blood transfusion during chemotherapy. Standard induction and consolidation chemotherapy was used (according to the PALG ALL-6 regiment).

Results: During consolidation cycles, darbepoietin alfa, intravenous iron, and total parenteral nutrition was administered. Extreme (Hb < 5 g/dL), long-lasting (41 days) anemia was observed with the lowest Hb concentration amounting to 1.3 g/dL (lasting 7 days).

Conclusion: We believe this to be the lowest Hb value observed, particularly one that persisted for such a long period of time and resulted in the patient surviving without consequences. The patient remains in complete remission for more than 2 years after diagnosis.

Publication types

  • Case Reports

MeSH terms

  • Anemia / chemically induced*
  • Anemia / therapy
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Blood Transfusion
  • Darbepoetin alfa / therapeutic use
  • Hematinics / therapeutic use
  • Hemoglobins / analysis
  • Humans
  • Iron / administration & dosage
  • Jehovah's Witnesses*
  • Male
  • Parenteral Nutrition, Total
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Remission Induction
  • Treatment Refusal
  • Young Adult

Substances

  • Hematinics
  • Hemoglobins
  • Darbepoetin alfa
  • Iron