Brunetta D M, Kaufman J, De Santis G C, Mesquita D F G, Souza F N O A, Garcia J H P
Walter Cantidio University Hospital, Federal University of Ceara, Hematology Division, Fortaleza, Ceará, Brazil.
Walter Cantidio University Hospital, Federal University of Ceara, Hematology Division, Fortaleza, Ceará, Brazil.
Transplant Proc. 2015 Oct;47(8):2548-51. doi: 10.1016/j.transproceed.2015.09.014.
There is no standard treatment for patients with severe anemia who refuse blood transfusion or cannot receive red blood cells.
After an orthotopic liver transplantation, an elderly Jehovah's Witness who refused blood transfusion presented with severe acute anemia with hemorrhagic shock. The calculated red blood cell loss was near 70%. Associated with surgical treatment and supportive measures, the patient was treated with high-dose erythropoietin and ferric carboxymaltose.
The patient presented a rapid increase in hemoglobin concentration and reticulocyte count with resolution of hemorrhagic shock after the proposed pharmacologic treatment combined with local hemostatic measures. She was transferred to a low-risk unit 4 days after transplantation and was discharged from the hospital on day 10. The hemoglobin concentration was normal 35 days after the bleeding event.
This case demonstrated that a protocol with high-dose erythropoietin and ferric carboxymaltose may be an option for patients with severe anemia who refuse blood transfusion or cannot receive red blood cells.
对于拒绝输血或无法接受红细胞输注的严重贫血患者，尚无标准治疗方法。
一位接受原位肝移植的老年耶和华见证会信徒拒绝输血，出现严重急性贫血并伴有失血性休克。计算得出红细胞丢失近70%。在采取手术治疗和支持措施的同时，给予患者大剂量促红细胞生成素和羧基麦芽糖铁治疗。
在采取拟用的药物治疗并结合局部止血措施后，患者血红蛋白浓度和网织红细胞计数迅速升高，失血性休克得到缓解。移植术后4天，她被转至低风险病房，并于第10天出院。出血事件发生35天后，血红蛋白浓度恢复正常。
本病例表明，对于拒绝输血或无法接受红细胞输注的严重贫血患者，大剂量促红细胞生成素和羧基麦芽糖铁联合治疗方案可能是一种选择。
