Thomas C Michelle, Coleman Harriet R, Morritt Taub Leslie-Faith
The University Center for Bloodless Surgery and Medicine at University Hospital, The University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
J Am Acad Nurse Pract. 2007 Jan;19(1):43-8. doi: 10.1111/j.1745-7599.2006.00188.x.
To discuss the diagnosis and treatment of severe anemia in an older adult who presents the challenge of declining blood transfusion in a real-world scenario where critical thinking, evidence-based care, and collaboration with other providers must come together to serve this patient's unique needs.
Extensive review of the scientific literature on anemia and the situation in which a patient refuses blood transfusion presented in a case study format.
A thorough physical assessment, complete health history, and appropriate diagnostic workup should be used to distinguish the normal effects of senescence from the signs and symptoms of anemia. Common conditions that cause anemia in the elderly include chronic disease, iron deficiency, and gastrointestinal bleeding. These conditions may result in profound anemia. The challenge can be compounded when, because of religious tenets, a patient does not accept a blood transfusion. This case study challenges nurse practitioners to apply knowledge, seek guidance, and make appropriate referrals to care for a patient in order to render care within the parameters of the patient's belief system.
The astute primary care provider recognizes that anemia is not an expected physiological change associated with aging but a manifestation of an underlying disease process. Fatigue, weakness, and dyspnea are all symptoms of anemia that may be overlooked and attributed to the aging process. Further, in keeping with the principles of autonomy and self-determination, it is the clinician's duty to work with all patients to restore them to a state of optimal health while respecting deeply held spiritual beliefs.
探讨在现实场景中，面对一位拒绝输血的老年重度贫血患者，如何进行诊断和治疗。在这种情况下，批判性思维、循证医疗以及与其他医疗服务提供者的协作必须结合起来，以满足该患者的特殊需求。
对关于贫血的科学文献以及以病例研究形式呈现的患者拒绝输血情况进行广泛综述。
应通过全面的体格检查、完整的健康史以及适当的诊断检查，来区分衰老的正常影响与贫血的体征和症状。导致老年人贫血的常见情况包括慢性病、缺铁和胃肠道出血。这些情况可能导致严重贫血。当患者因宗教教义而不接受输血时，挑战会更加复杂。本病例研究促使执业护士运用知识、寻求指导并进行适当转诊，以便在患者信仰体系的框架内为患者提供护理。
敏锐的初级保健提供者认识到，贫血并非与衰老相关的预期生理变化，而是潜在疾病过程的一种表现。疲劳、虚弱和呼吸困难都是贫血的症状，可能会被忽视并归因于衰老过程。此外，根据自主和自决原则，临床医生有责任与所有患者合作，在尊重其深刻的精神信仰的同时，使他们恢复到最佳健康状态。
