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==Background==
Jehovah's Witness patients refuse allogenic blood and blood products.  The major clinical complication due to their religious beliefs 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>
*Erythropoesis stimulation
*Iron supplementation
*Oxygen carriers
*Whole blood conservation
The use of advanced treatments are generally reserved for patients with severe anemia < 7g/dL
==Control Bleeding==
*Early surgical or hemostatic control
*[[Tranexamic Acid]] administration for major trauma < 3 hrs
*[[Prothrombin complex concentrates]]
*Recombinant factor VIIa
==Erythropoesis Stimulation==
High dose eppetin 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(Pt 6):1265- 71.</ref>

===Epoetin alfa (Epogen)===
*Dose: 40,000 unites 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
*Patients must have sufficient iron supplementation or max erythropoesis will not occur
==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>
*IV iron sucrose 100 mg daily for 10 days<ref name="JW"></ref>
*Oral [[Iron Supplementation]] afterwards
==Vitamin Supplementation==
Should be provided to all patients
*Vitamin C: 500 mg TID( q24hrs daily in renal failure)
*Folate: 1 mg PO or IV daily (q24hrs)
*Vitamin B12 multivitamin PO or IV

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

==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
(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
**If patient develops hypertension slow infusion rate

==See Also==
*[[Anemia]]

==External Links==

==References==
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