[Treating severe acute anemia due to vaginal bleeding in the Jehovah's Witness: a report of 2 cases].
For reasons of religious belief, Jehova's Witnesses do not accept blood transfusions or the infusion of blood products. In situations in which severe, life-threatening anemia develops, patient refusal to receive a transfusion can create serious ethical and legal problems. The principle of patient autonomy, which implies the freedom to accept or reject treatment, comes into conflict with the physician's obligation to safeguard the patient's life using all means possible. We report 2 cases of severe anemia in Jehova's Witnesses. One was due to menorrhagia and the other to postpartum bleeding. The physician should be aware of alternatives to infusion of blood products and know how to cope with an unexpected critical event in these patients. The measures we took were effective in our patients. In the case of menorrhagia, hormone treatment is effective when the woman wishes to preserve the ability to conceive and avoid surgery (endometrial ablation and hysterectomy). In postpartum bleeding refractory to conservative treatment, selective embolization of bleeding vessels may make it unnecessary to resort to more aggressive treatment, such as obstetric hysterectomy.
Servicio Anestesiología y Reanimación, Hospital Universitario Maternal La Paz, Madrid. ilegredilla@hotmail.com
E
E
Gredilla
A
A
Pérez-Ferrer
E
E
Canser
E
E
Alonso
B
B
Martínez Serrano
F
F
Gilsanz
D000328:Adult; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D002584:Cervix Uteri / Q000293:injuries; D003131:Combined Modality Therapy; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D017985:Dalteparin / Q000627:therapeutic use; D004621:Embolization, Therapeutic; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005290:Ferric Compounds / Q000627:therapeutic use; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; D006801:Humans; D007103:Immobilization; D033221:Jehovah's Witnesses; D008595:Menorrhagia / Q000150:complications*; D010102:Oxygen Inhalation Therapy; D010288:Parenteral Nutrition; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011994:Recombinant Proteins; D013923:Thromboembolism / Q000517:prevention & control; D016312:Treatment Refusal; D055815:Young Adult
D014151:Anti-Anxiety Agents; D000925:Anticoagulants; D003278:Contraceptives, Oral, Hormonal; D005290:Ferric Compounds; D011994:Recombinant Proteins; D004921:Erythropoietin; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; D017985:Dalteparin