Let us use physiologic transfusion triggers: Favorable outcome in an 86-year-old Jehovah's witness with a haemoglobin nadir of 44g L-1

摘要

The number of Jehovah's Witnesses worldwide is estimated at approximately 8.6 million. As Jehovah's Witnesses refuse administration of blood and blood-derived products on religious grounds, transfusion of red blood cells is not an option. It is especially problematic when anaemia develops acutely, as in non-elective surgery, as there is no time to optimise volume of red blood cells preoperatively. We present a case of an 86-year-old woman who underwent non-elective laparoscopic cholecystectomy due to gangrenous cholecystitis. Post-operatively the patient was hospitalised in an intensive care unit where the haemoglobin concentration reached nadir of 44 g L-1. Despite developing severe anaemia, the patient survived and did not suffer from long-term sequelae. To our knowledge, the patient presented here was the oldest patient who survived anaemia of such severity to date. When deciding on red blood cells transfusion clinicians should consider patient's physiologic response to anaemia, as tolerance of anaemia is variable among patients. Even elderly patients may tolerate severe anaemia, as it has been shown in our care report.