title: Postoperative management of severe acute anemia in a Jehovah's Witness.
abstract: BACKGROUND
  Low levels of hemoglobin (Hb) are not rare in patients who refuse blood components but this case is unique due to the severity of anemia and the possibility that her previous episode of acute normovolemic hemodilution has influenced her outcome.
  
  
  METHODS
  We report an incident involving acute blood loss after surgery with an extremely low hematocrit. Despite her Hb levels (2.8 g/dL) she remained lucid, expressing her wish not to receive transfusion. When the patient lost consciousness (Hb, 1.4 g/dL) she was promptly sedated, curarized, and put onto mechanical controlled ventilation. Aggressive erythropoietin therapy increased the patient's Hb level by 240% in 10 days, despite a high platelet count. This case demonstrates that critical levels of oxygen delivery may be lower than previously thought possible.
  
  
  CONCLUSIONS
  This case is an example of the resilience of the human body in an extreme circumstance. It might be the most severe case of anemia that a person has survived without any sequelae.
authors.affiliation: Discipline of Anesthesiology, Department of Biomechanics, Medicine and Rehabilitation of Locomotor System, Faculty of Medicine of Ribeirao Preto, USP, Brazil.
authors.forename: Liana Maria Tôrres
authors.initials: LM
authors.lastname: de Araújo Azi
authors.forename: Fernando Muniz
authors.initials: FM
authors.lastname: Lopes
authors.forename: Luis Vicente
authors.initials: LV
authors.lastname: Garcia
mesh_terms: D000208:Acute Disease; D000328:Adult; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D001803:Blood Transfusion / Q000523:psychology; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D033221:Jehovah's Witnesses; D019106:Postoperative Hemorrhage / Q000150:complications* / Q000628:therapy*; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D016312:Treatment Refusal
chemical_list: D004921:Erythropoietin