title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Hematology Division, Fortaleza, Ceará, Brazil. Electronic address: dbrunetta@hotmail.com.
authors.forename: D M
authors.initials: DM
authors.lastname: Brunetta
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Hematology Division, Fortaleza, Ceará, Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Kaufman
authors.affiliation: Center for Cell Based Therapy, Medical School of Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
authors.forename: G C
authors.initials: GC
authors.lastname: De Santis
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Liver Transplantation Division, Fortaleza, Ceará, Brazil.
authors.forename: D F G
authors.initials: DF
authors.lastname: Mesquita
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Liver Transplantation Division, Fortaleza, Ceará, Brazil.
authors.forename: F N O A
authors.initials: FN
authors.lastname: Souza
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Liver Transplantation Division, Fortaleza, Ceará, Brazil.
authors.forename: J H P
authors.initials: JH
authors.lastname: Garcia
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D005290:Ferric Compounds / Q000627:therapeutic use*; D006801:Humans; D033221:Jehovah's Witnesses; D016031:Liver Transplantation / Q000009:adverse effects*; D008320:Maltose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D017701:Reticulocyte Count; D012771:Shock, Hemorrhagic / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D016312:Treatment Refusal
chemical_list: D005290:Ferric Compounds; D004921:Erythropoietin; C522335:ferric carboxymaltose; D008320:Maltose