Recovery From Hemoglobin Of 2g/Dl Without Prbc Transfusion: A Lesson Learned From a Jehovah’s Witness With Cold Agglutinin Disease

Supportive management of critically ill patients with anemia often involves packed red blood cell transfusion. Jehovah’s Witness’ refusal of blood products because of their religious beliefs can render these situations challenging. Successful adaptation of medical management in Jehovah’s Witness’ with severe anemia provides physicians with a distinct opportunity to question common transfusion practices and learn about anemia. We present a case of a 43 year-old Jehovahs Witness who presented with autoimmune hemolytic anemia – cold agglutinin disease. His hemoglobin nadired at 2g/dL. The patient was successfully managed to recovery with corticosteroids, rituximab, folic acid and an erythropoeitin stimulating agent. To our knowledge this is the lowest Hgb that a patient with life threatening cold agglutinin disease survived without the use of any blood product transfusion. Such cases afford a deeper appreciation of the body's ability to adapt to and recover from anemia without the use of exogenous blood.