Severe anemia in Jehovah's Witness patients - Revision history

Rossdonaldson1: Rossdonaldson1 moved page Jehovah's Witness patients to Severe anemia in Jehovah's Witness patients

2018-03-25T14:26:45Z

Rossdonaldson1 moved page Jehovah's Witness patients to Severe anemia in Jehovah's Witness patients

← Older revision	Revision as of 14:26, 25 March 2018
(No difference)

Pascualj: /* Background */

2018-02-21T01:48:12Z

Background

← Older revision		Revision as of 01:48, 21 February 2018
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	==Background==		==Background==
	Jehovah's Witness ~~patients~~ traditionally refuse allogenic blood and blood products. This can make cases of life threatening bleeding difficult to address. However, multiple options exist to temporize and treat bleeding which are acceptable to Jehovah's Witness patients. These include:<ref>Gannon CJ, Napolitano LM. Severe anemia after gastrointestinal hemorrhage in a Jehovah’s Witness: new treatment strategies. Crit Care Med 2002;30:1893-5.</ref>		Jehovah's Witness paients traditionally refuse allogenic blood and whole blood products.
	*Erythropoesis stimulation		*This includes: RBCs, plasma, platelets, white cells) <ref>https://www.jw.org/en/jehovahs-witnesses/faq/jehovahs-witnesses-why-no-blood-transfusions/</ref>
			*HOWEVER, they are able to choose to accept BLOOD COMPONENT FRACTIONS (includes recombinant factor VII, PCC), though this decision may still vary per individual. <ref>https://wol.jw.org/en/wol/d/r1/lp-e/2004448#h=4</ref>

			This can make cases of life threatening bleeding difficult to address. However, multiple options exist to temporize and treat bleeding which are acceptable to Jehovah's Witness patients. These include:<ref>Gannon CJ, Napolitano LM. Severe anemia after gastrointestinal hemorrhage in a Jehovah’s Witness: new treatment strategies. Crit Care Med 2002;30:1893-5.</ref>
			*Erythropoesis stimulation
	*Iron supplementation		*Iron supplementation
	*Oxygen carriers		*Oxygen carriers
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	==hemoglobin-Based Oxygen Carriers (Hemapure)==		==hemoglobin-Based Oxygen Carriers (Hemapure)==
	Hemapure ~~require~~ individual patient IRB and institutional FDA approval and is experimental. Hemopure is approved in South Africa and Russia and is a purifiec acellular bovine hemoglobin in lactated ringer's solution<ref>ClinicalTrials.gov. Expanded access study of HBOC-201		In the US, Hemapure requires individual patient IRB and institutional FDA approval and is experimental.
			*May be able to use this on a US patient by requesting "Expanded Access/Compassionate Care" protocol from FDA (see: https://www.fda.gov/NewsEvents/PublicHealthFocus/ExpandedAccessCompassionateUse/)

			Hemopure is approved in South Africa and Russia and is a purifiec acellular bovine hemoglobin in lactated ringer's solution<ref>ClinicalTrials.gov. Expanded access study of HBOC-201
	(Hemopure) for the treatment of life-threatening anemia. 2014. [http:// clinicaltrials.gov/ct2/show/NCT01881503]</ref>		(Hemopure) for the treatment of life-threatening anemia. 2014. [http:// clinicaltrials.gov/ct2/show/NCT01881503]</ref>
	*Dosing: 1 unit (225 mL) administered IV over 4 hours if bleeding		*Dosing: 1 unit (225 mL) administered IV over 4 hours if bleeding

Mholtz at 20:03, 24 December 2016

2016-12-24T20:03:57Z

← Older revision		Revision as of 20:03, 24 December 2016
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	==Background==		==Background==
	Jehovah's Witness patients traditionally refuse allogenic blood and blood products. ~~The major clinical complication due to this is~~ life threatening bleeding. ~~Multiple~~ options exist to temporize and treat bleeding, which include:<ref>Gannon CJ, Napolitano LM. Severe anemia after gastrointestinal hemorrhage in a Jehovah’s Witness: new treatment strategies. Crit Care Med 2002;30:1893-5.</ref>		Jehovah's Witness patients traditionally refuse allogenic blood and blood products. This can make cases of life threatening bleeding difficult to address. However, multiple options exist to temporize and treat bleeding which are acceptable to Jehovah's Witness patients. These include:<ref>Gannon CJ, Napolitano LM. Severe anemia after gastrointestinal hemorrhage in a Jehovah’s Witness: new treatment strategies. Crit Care Med 2002;30:1893-5.</ref>
	*Erythropoesis stimulation		*Erythropoesis stimulation
	*Iron supplementation		*Iron supplementation
	*Oxygen carriers		*Oxygen carriers
	*Whole blood conservation		*Whole blood conservation
	~~The use of advanced treatments are generally reserved for patients with severe anemia < 7g/dL~~

	~~Individual~~ Jehovah's Witnesses may not strictly adhere to this doctrine; up to 49% of Jehovah's Witness patients in one study would be willing to accept blood products in certain circumstances. <ref>Gyamfi C, Berkowitz RL. Responses by pregnant Jehovah's Witnesses on health care proxies. Obstet Gynecol. 2004;104(3):541-4.</ref> It's worth carefully discussing the risks/benefits with the patient (without visitors present), especially if the need is truly critical.		It is important to note that individual Jehovah's Witnesses may not strictly adhere to this doctrine; up to 49% of Jehovah's Witness patients in one study would be willing to accept blood products in certain circumstances. <ref>Gyamfi C, Berkowitz RL. Responses by pregnant Jehovah's Witnesses on health care proxies. Obstet Gynecol. 2004;104(3):541-4.</ref> It's worth carefully discussing the risks/benefits with the patient (without visitors present), especially if the need is truly critical.

	==Control Bleeding==		==Control Bleeding==
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	==Erythropoesis Stimulation==		==Erythropoesis Stimulation==
	High dose epoetin ~~have~~ a multimodal mechanism of action that includes an increase in reticulocyte count, decrease in plasma volume and increase in hemoglobin levels<ref>Lundby C, Olsen NV. Effects of recombinant human erythropoietin in normal humans. J Physiol 2011;589(Patient 6):1265- 71.</ref>		High dose epoetin has a multimodal mechanism of action that includes an increase in reticulocyte count, decrease in plasma volume and increase in hemoglobin levels<ref>Lundby C, Olsen NV. Effects of recombinant human erythropoietin in normal humans. J Physiol 2011;589(Patient 6):1265- 71.</ref>

	===Epoetin Alfa (Epogen)===		===Epoetin Alfa (Epogen)===
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	*[[Vitamin B12]] multivitamin PO or IV		*[[Vitamin B12]] multivitamin PO or IV

	==Decrease ~~Phelbotomy~~==		==Decrease Phlebotomy==
	*Use pediatric tubes for blood draws and limit daily volume to 1mL		*Use pediatric tubes for blood draws and limit daily volume to 1mL

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	==External Links==		==External Links==


	==References==		==References==

ClaireLewis: /* Vitamin Supplementation */

2016-12-22T23:26:44Z

Vitamin Supplementation

← Older revision		Revision as of 23:26, 22 December 2016
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	*Vitamin C: 500mg TID( q24hrs daily in renal failure)		*Vitamin C: 500mg TID( q24hrs daily in renal failure)
	*[[Folate]]: 1mg PO or IV daily (q24hrs)		*[[Folate]]: 1mg PO or IV daily (q24hrs)
	*Vitamin B12 multivitamin PO or IV		*[[Vitamin B12]] multivitamin PO or IV

	==Decrease Phelbotomy==		==Decrease Phelbotomy==

ClaireLewis: /* Vitamin Supplementation */

2016-12-22T22:50:13Z

Vitamin Supplementation

← Older revision		Revision as of 22:50, 22 December 2016
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	Should be provided to all patients		Should be provided to all patients
	*Vitamin C: 500mg TID( q24hrs daily in renal failure)		*Vitamin C: 500mg TID( q24hrs daily in renal failure)
	*Folate: 1mg PO or IV daily (q24hrs)		*[[Folate]]: 1mg PO or IV daily (q24hrs)
	*Vitamin B12 multivitamin PO or IV		*Vitamin B12 multivitamin PO or IV

Rossdonaldson1: Text replacement - "Hb" to "hemoglobin"

2016-08-01T15:00:01Z

Text replacement - "Hb" to "hemoglobin"

← Older revision		Revision as of 15:00, 1 August 2016
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	==Erythropoesis Stimulation==		==Erythropoesis Stimulation==
	High dose epoetin have a multimodal mechanism of action that includes an increase in reticulocyte count, decrease in plasma volume and increase in Hb levels<ref>Lundby C, Olsen NV. Effects of recombinant human erythropoietin in normal humans. J Physiol 2011;589(Patient 6):1265- 71.</ref>		High dose epoetin have a multimodal mechanism of action that includes an increase in reticulocyte count, decrease in plasma volume and increase in hemoglobin levels<ref>Lundby C, Olsen NV. Effects of recombinant human erythropoietin in normal humans. J Physiol 2011;589(Patient 6):1265- 71.</ref>

	===Epoetin Alfa (Epogen)===		===Epoetin Alfa (Epogen)===
	*Dose: 40,000 units IV daily until Hb > 7g/dL then 40,000 units per week<ref name="JW">Posluszny JA Jr, Napolitano LM. How do we treat life-threatening anemia in a Jehovah's Witness patient? Transfusion. 2014;54(12):3026-3034. doi:10.1111/trf.12888.</ref>		*Dose: 40,000 units IV daily until hemoglobin > 7g/dL then 40,000 units per week<ref name="JW">Posluszny JA Jr, Napolitano LM. How do we treat life-threatening anemia in a Jehovah's Witness patient? Transfusion. 2014;54(12):3026-3034. doi:10.1111/trf.12888.</ref>
	*Onset of Action: 3 days		*Onset of Action: 3 days
	*Patients must have sufficient iron supplementation or max erythropoesis will not occur		*Patients must have sufficient iron supplementation or max erythropoesis will not occur
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	*Use pediatric tubes for blood draws and limit daily volume to 1mL		*Use pediatric tubes for blood draws and limit daily volume to 1mL

	==Hb-Based Oxygen Carriers (Hemapure)==		==hemoglobin-Based Oxygen Carriers (Hemapure)==
	Hemapure require individual patient IRB and institutional FDA approval and is experimental. Hemopure is approved in South Africa and Russia and is a purifiec acellular bovine Hb in lactated ringer's solution<ref>ClinicalTrials.gov. Expanded access study of HBOC-201		Hemapure require individual patient IRB and institutional FDA approval and is experimental. Hemopure is approved in South Africa and Russia and is a purifiec acellular bovine hemoglobin in lactated ringer's solution<ref>ClinicalTrials.gov. Expanded access study of HBOC-201
	(Hemopure) for the treatment of life-threatening anemia. 2014. [http:// clinicaltrials.gov/ct2/show/NCT01881503]</ref>		(Hemopure) for the treatment of life-threatening anemia. 2014. [http:// clinicaltrials.gov/ct2/show/NCT01881503]</ref>
	*Dosing: 1 unit (225 mL) administered IV over 4 hours if bleeding		*Dosing: 1 unit (225 mL) administered IV over 4 hours if bleeding

Neil.m.young at 17:55, 26 July 2016

2016-07-26T17:55:14Z

← Older revision		Revision as of 17:55, 26 July 2016
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	High dose epoetin have a multimodal mechanism of action that includes an increase in reticulocyte count, decrease in plasma volume and increase in Hb levels<ref>Lundby C, Olsen NV. Effects of recombinant human erythropoietin in normal humans. J Physiol 2011;589(Patient 6):1265- 71.</ref>		High dose epoetin have a multimodal mechanism of action that includes an increase in reticulocyte count, decrease in plasma volume and increase in Hb levels<ref>Lundby C, Olsen NV. Effects of recombinant human erythropoietin in normal humans. J Physiol 2011;589(Patient 6):1265- 71.</ref>

	===Epoetin ~~alfa~~ (Epogen)===		===Epoetin Alfa (Epogen)===
	*Dose: 40,000 units IV daily until Hb > 7g/dL then 40,000 units per week<ref name="JW">Posluszny JA Jr, Napolitano LM. How do we treat life-threatening anemia in a Jehovah's Witness patient? Transfusion. 2014;54(12):3026-3034. doi:10.1111/trf.12888.</ref>		*Dose: 40,000 units IV daily until Hb > 7g/dL then 40,000 units per week<ref name="JW">Posluszny JA Jr, Napolitano LM. How do we treat life-threatening anemia in a Jehovah's Witness patient? Transfusion. 2014;54(12):3026-3034. doi:10.1111/trf.12888.</ref>
	*Onset of Action: 3 days		*Onset of Action: 3 days
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	*Vitamin B12 multivitamin PO or IV		*Vitamin B12 multivitamin PO or IV

	==Decrease ~~phelbotomy~~==		==Decrease Phelbotomy==
	*Use pediatric tubes for blood draws and limit daily volume to 1mL		*Use pediatric tubes for blood draws and limit daily volume to 1mL

	==Hb-~~based oxygen carriers~~ (Hemapure)==		==Hb-Based Oxygen Carriers (Hemapure)==
	Hemapure require individual patient IRB and institutional FDA approval and is experimental. Hemopure is approved in South Africa and Russia and is a purifiec acellular bovine Hb in lactated ringer's solution<ref>ClinicalTrials.gov. Expanded access study of HBOC-201		Hemapure require individual patient IRB and institutional FDA approval and is experimental. Hemopure is approved in South Africa and Russia and is a purifiec acellular bovine Hb in lactated ringer's solution<ref>ClinicalTrials.gov. Expanded access study of HBOC-201
	(Hemopure) for the treatment of life-threatening anemia. 2014. [http:// clinicaltrials.gov/ct2/show/NCT01881503]</ref>		(Hemopure) for the treatment of life-threatening anemia. 2014. [http:// clinicaltrials.gov/ct2/show/NCT01881503]</ref>

Neil.m.young: Text replacement - "5 mg" to "5mg"

2016-07-20T23:58:23Z

Text replacement - "5 mg" to "5mg"

← Older revision		Revision as of 23:58, 20 July 2016
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	*Iron supplementation to keep serum iron 100-400mg/dl		*Iron supplementation to keep serum iron 100-400mg/dl
	*IV iron sucrose 100mg daily for 10 days<ref name="JW"></ref>		*IV iron sucrose 100mg daily for 10 days<ref name="JW"></ref>
	**For first dose, test dose ~~25 mg~~ slow push over 15 min		**For first dose, test dose 25mg slow push over 15 min
	**Wait 2 hrs, if no anaphylactoid reaction, give rest of ~~75 mg~~		**Wait 2 hrs, if no anaphylactoid reaction, give rest of 75mg
	*Oral [[Iron Supplementation]] afterwards		*Oral [[Iron Supplementation]] afterwards

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-20T08:26:30Z

Text replacement - "0 mg" to "0mg"

← Older revision		Revision as of 08:26, 20 July 2016
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	==Iron Supplementation==		==Iron Supplementation==
	Supplementation will allow for full RBC production but will not correct anemia immediately. Most useful for preparing for scheduled surgical procedures or in burn patients<ref>Barsun A et al. Reducing postburn injury anemia in a Jehovah’s Witness patient. J Burn Care Res 2014;35:e258-61.</ref>		Supplementation will allow for full RBC production but will not correct anemia immediately. Most useful for preparing for scheduled surgical procedures or in burn patients<ref>Barsun A et al. Reducing postburn injury anemia in a Jehovah’s Witness patient. J Burn Care Res 2014;35:e258-61.</ref>
	*Iron supplementation to keep serum iron 100-~~400 mg~~/dl		*Iron supplementation to keep serum iron 100-400mg/dl
	*IV iron sucrose ~~100 mg~~ daily for 10 days<ref name="JW"></ref>		*IV iron sucrose 100mg daily for 10 days<ref name="JW"></ref>
	**For first dose, test dose 25 mg slow push over 15 min		**For first dose, test dose 25 mg slow push over 15 min
	**Wait 2 hrs, if no anaphylactoid reaction, give rest of 75 mg		**Wait 2 hrs, if no anaphylactoid reaction, give rest of 75 mg
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	==Vitamin Supplementation==		==Vitamin Supplementation==
	Should be provided to all patients		Should be provided to all patients
	*Vitamin C: ~~500 mg~~ TID( q24hrs daily in renal failure)		*Vitamin C: 500mg TID( q24hrs daily in renal failure)
	*Folate: 1mg PO or IV daily (q24hrs)		*Folate: 1mg PO or IV daily (q24hrs)
	*Vitamin B12 multivitamin PO or IV		*Vitamin B12 multivitamin PO or IV

Neil.m.young: Text replacement - "1 mg" to "1mg"

2016-07-19T13:33:25Z

Text replacement - "1 mg" to "1mg"

← Older revision		Revision as of 13:33, 19 July 2016
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	Should be provided to all patients		Should be provided to all patients
	*Vitamin C: 500 mg TID( q24hrs daily in renal failure)		*Vitamin C: 500 mg TID( q24hrs daily in renal failure)
	*Folate: ~~1 mg~~ PO or IV daily (q24hrs)		*Folate: 1mg PO or IV daily (q24hrs)
	*Vitamin B12 multivitamin PO or IV		*Vitamin B12 multivitamin PO or IV