Severe Acute Anemia After Liver Transplantation in an Elderly Jehovah's Witness Treated With High-dose Erythropoietin and Ferric Carboxymaltose: A Case Report.

Abstract

BACKGROUND:

There is no standard treatment for patients with severe anemia who refuse blood transfusion or cannot receive red blood cells.

CASE REPORT:

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.

RESULTS:

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.

CONCLUSION:

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.

• Authors: D M Brunetta, J Kaufman, G C De Santis, D F G Mesquita, F N O A Souza, J H P Garcia
• Journal: Transplantation proceedings (Transplant Proc) Vol. 47 Issue 8 Pg. 2548-51 (Oct 2015) ISSN: 1873-2623 [Electronic] United States
• PMID: 26518969 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Ferric Compounds
• Erythropoietin
• ferric carboxymaltose
• Maltose

Topics

• Anemia (drug therapy, etiology)
• Blood Transfusion (statistics & numerical data)
• Erythropoietin (administration & dosage)
• Female
• Ferric Compounds (therapeutic use)
• Humans
• Jehovah's Witnesses
• Liver Transplantation (adverse effects)
• Maltose (analogs & derivatives, therapeutic use)
• Middle Aged
• Reticulocyte Count
• Shock, Hemorrhagic (drug therapy, etiology)
• Treatment Outcome
• Treatment Refusal