title: A case study of an older adult with severe anemia refusing blood transfusion.
abstract: OBJECTIVE
  To discuss the diagnosis and treatment of severe anemia in an older adult who presents the challenge of declining blood transfusion in a real-world scenario where critical thinking, evidence-based care, and collaboration with other providers must come together to serve this patient's unique needs.
  
  
  METHODS
  Extensive review of the scientific literature on anemia and the situation in which a patient refuses blood transfusion presented in a case study format.
  
  
  CONCLUSIONS
  A thorough physical assessment, complete health history, and appropriate diagnostic workup should be used to distinguish the normal effects of senescence from the signs and symptoms of anemia. Common conditions that cause anemia in the elderly include chronic disease, iron deficiency, and gastrointestinal bleeding. These conditions may result in profound anemia. The challenge can be compounded when, because of religious tenets, a patient does not accept a blood transfusion. This case study challenges nurse practitioners to apply knowledge, seek guidance, and make appropriate referrals to care for a patient in order to render care within the parameters of the patient's belief system.
  
  
  CONCLUSIONS
  The astute primary care provider recognizes that anemia is not an expected physiological change associated with aging but a manifestation of an underlying disease process. Fatigue, weakness, and dyspnea are all symptoms of anemia that may be overlooked and attributed to the aging process. Further, in keeping with the principles of autonomy and self-determination, it is the clinician's duty to work with all patients to restore them to a state of optimal health while respecting deeply held spiritual beliefs.
authors.affiliation: The University Center for Bloodless Surgery and Medicine at University Hospital, The University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA. thomasmc@umdnj.edu
authors.forename: C Michelle
authors.initials: CM
authors.lastname: Thomas
authors.forename: Harriet R
authors.initials: HR
authors.lastname: Coleman
authors.forename: Leslie-Faith
authors.initials: LF
authors.lastname: Morritt Taub
mesh_terms: D000368:Aged; D000465:Algorithms; D000740:Anemia / Q000175:diagnosis / Q000209:etiology / Q000523:psychology* / Q000628:therapy*; D001803:Blood Transfusion / Q000451:nursing / Q000523:psychology*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D058085:Iron Compounds / Q000627:therapeutic use; D033221:Jehovah's Witnesses / Q000523:psychology*; D009722:Nurse Practitioners / Q000458:organization & administration* / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D009730:Nursing Assessment; D010347:Patient Care Planning; D010353:Patient Education as Topic; D010808:Physical Examination; D011320:Primary Health Care / Q000458:organization & administration; D012017:Referral and Consultation; D012069:Religion and Psychology; D016312:Treatment Refusal / Q000523:psychology*
chemical_list: D006397:Hematinics; D058085:Iron Compounds