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Kidney Week

Abstract: TH-PO946

Case Report on Successful Treatment of Life-Threatening Anemia in ESRD Patient on Maintenance Hemodialysis Who Is a Jehovah Witness and Refusing Blood Transfusion

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Elhawary, Omar Nabil, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
  • Sasidharan, Sandeep Raja, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
  • Bukhari, Syeda Sadia, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
  • Puri, Isha, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
  • Mallappallil, Mary C., SUNY Downstate Health Sciences University, Brooklyn, New York, United States

Group or Team Name

  • Kings County Team.
Introduction

Anemia is prevalent in patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) who undergo regular hemodialysis. This is primarily attributed to reduced production of erythropoietin by the kidneys. Existing guidelines recommend managing anemia when the hemoglobin (Hgb) is below 11 g/dL by administering intravenous iron and erythropoietin injections. In cases who have severe anemia with hemoglobin levels below 7-8 g/dL and experience symptoms, blood transfusion is typically recommended. Blood transfusions help in correcting anemia, alleviating symptoms, and enhancing tissue oxygenation. However, providing appropriate treatment for anemia becomes challenging when patients refuse blood transfusion due to religious beliefs, such as our patient. In our case report, we present a successful treatment approach for severe anemia in an ESRD patient without utilizing blood transfusions.

Case Description

60-year-old woman with history of Hypertension, ESRD on hemodialysis (HD) due to Systemic lupus erythematosus with failed kidney transplant presented with altered mentation. She was found hemodynamically unstable, in atrial-flutter requiring ablation and cardiac monitoring on admission. She had a long hospitalization with Hgb at presentation~9. It gradually went down to 4.8 over 3 weeks. Due to her religious beliefs as a Jehovah’s witness, she declined blood transfusion. To treat her anemia, we initiated a daily treatment regimen consisting of short-acting erythropoietin alfa at a dose of 40,000 Units for seven days, along with daily intravenous iron sucrose at 100 mg. After one week of this treatment, the patient's hemoglobin level improved to 11.5 g/dL and felt markedly better.

Discussion

For Jehovah Witness patients undergoing HD, who have severe anemia and decline blood transfusions, we suggest initiating a daily, short-term treatment of erythropoietin alfa at a dosage of 40,000 U, alongside intravenous iron, for a duration of one week. If the patient is already receiving long-acting darbepoetin alfa, it is advised to transition to short-acting erythropoietin alfa. This approach may also be applied for preoperative management of significant anemia, regardless of whether the patients are receiving renal replacement therapy or not.