title: Erythropoietin use in a pregnant Jehovah's witness with anemia and beta-thalassemia: a case report.
abstract: BACKGROUND
  Anemia in pregnancy is seen often because of iron deficiency and the "physiologic dilution" that occurs in the third trimester. Other causes include genetic conditions, such as sickle cell anemia and thalassemias. In cases not responding to iron therapy, patients occasionally require a blood transfusion to restore adequate circulating red blood cell mass. In patients belonging to the Jehovah's Witness sect, transfusion of blood products is not allowed, and treatment of anemia in pregnancy may require use of erythropoietin.
  
  
  METHODS
  A 26-year-old, African American woman belonging to the Jehovah's Witness sect presented with anemia associated with beta-thalassemia. Iron therapy and prenatal vitamins did not correct the anemia, and the patient became symptomatic, with fatigue and shortness of breath when walking. Therapy with synthetic erythropoietin corrected the anemia, and the patient had an otherwise-uncomplicated pregnancy and delivery.
  
  
  CONCLUSIONS
  Synthetic erythropoietin has been used successfully in patients with renal failure and anemia. In pregnancy associated with renal failure and anemia, synthetic erythropoietin has been shown to be safe except for rare cases of hypertension. We treated anemia caused by beta-thalassemia in pregnancy with synthetic erythropoietin to avoid a transfusion in a Jehovah's Witness.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, George Washington University School of Medicine, Washington, DC 20037, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bennett
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Macri
authors.forename: Susanne L
authors.initials: SL
authors.lastname: Bathgate
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000188:drug therapy*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D033221:Jehovah's Witnesses; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000188:drug therapy*; D011256:Pregnancy Outcome; D018570:Risk Assessment; D016896:Treatment Outcome; D017086:beta-Thalassemia / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D004921:Erythropoietin