Posluszny Joseph A, Napolitano Lena M
Division of Acute Care Surgery [Trauma, Burns, Critical Care, Emergency Surgery], Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Transfusion. 2014 Dec;54(12):3026-34. doi: 10.1111/trf.12888. Epub 2014 Oct 21.
The refusal of allogeneic human blood and blood products by Jehovah's Witness (JW) patients complicates the treatment of life-threatening anemia. For JW patients, when hemoglobin (Hb) levels decrease beyond traditional transfusion thresholds (<7 g/dL), alternative methods to allogeneic blood transfusion can be utilized to augment erythropoiesis and restore endogenous Hb levels. The use of erythropoietin-stimulating agents and intravenous iron has been shown to restore red blood cell and Hb levels in JW patients, although these effects may be significantly delayed. When JW patients have evidence of life-threatening anemia (Hb <5 g/dL), oxygen-carrying capacity can be supplemented with the administration of Hb-based oxygen carriers (HBOCs). Although HBOCs are not Food and Drug Administration (FDA) approved, they may be obtained and administered with FDA, institutional review board, and patient approval. We describe a protocol-based algorithm to the management of life-threatening anemia in JW patients and review time to anemia reversal and patient outcomes using this approach.
耶和华见证会（JW）患者拒绝接受异体人血及血液制品，这使得危及生命的贫血症治疗变得复杂。对于JW患者，当血红蛋白（Hb）水平降至传统输血阈值以下（<7 g/dL）时，可以采用异体输血的替代方法来增强红细胞生成并恢复内源性Hb水平。促红细胞生成素刺激剂和静脉铁剂的使用已被证明可恢复JW患者的红细胞和Hb水平，尽管这些效果可能会显著延迟。当JW患者出现危及生命的贫血证据（Hb <5 g/dL）时，可通过给予基于血红蛋白的氧载体（HBOC）来补充氧携带能力。尽管HBOC未获美国食品药品监督管理局（FDA）批准，但在获得FDA、机构审查委员会和患者批准后，仍可获取并使用。我们描述了一种基于方案的算法，用于管理JW患者危及生命的贫血症，并使用这种方法回顾贫血逆转时间和患者预后。
