title: Long-lasting extreme anemia during the therapy of acute lymphoblastic leukemia in a Jehovah's Witness patient.
abstract: BACKGROUND
  The treatment of patients with acute leukemia, who due to their religious beliefs refuse to accept blood transfusion, is a great challenge for hematologists.
  
  
  METHODS
  We present a case of acute pre-T-lymphoblastic leukemia in a Jehovah's Witness who did not accept blood transfusion during chemotherapy. Standard induction and consolidation chemotherapy was used (according to the PALG ALL-6 regiment).
  
  
  RESULTS
  During consolidation cycles, darbepoietin alfa, intravenous iron, and total parenteral nutrition was administered. Extreme (Hb < 5 g/dL), long-lasting (41 days) anemia was observed with the lowest Hb concentration amounting to 1.3 g/dL (lasting 7 days).
  
  
  CONCLUSIONS
  We believe this to be the lowest Hb value observed, particularly one that persisted for such a long period of time and resulted in the patient surviving without consequences. The patient remains in complete remission for more than 2 years after diagnosis.
authors.affiliation: Department of Hemostasis, Medical University of Łódź, and the, Łódź, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Chojnowski
authors.affiliation: Department of Hematology, Copernicus Memorial Hospital, Łódź, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Janus
authors.affiliation: Department of Hematology, Copernicus Memorial Hospital, Łódź, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Bliźniewska
authors.affiliation: Department of Hemostasis, Medical University of Łódź, and the, Łódź, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Robak
authors.affiliation: Department of Hemostasis, Medical University of Łódź, and the, Łódź, Poland. jacek.trelinski@umed.lodz.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Treliński
mesh_terms: D000740:Anemia / Q000139:chemically induced* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001803:Blood Transfusion; D000068256:Darbepoetin alfa / Q000627:therapeutic use; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D033221:Jehovah's Witnesses; D008297:Male; D010289:Parenteral Nutrition, Total; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012074:Remission Induction; D016312:Treatment Refusal; D055815:Young Adult
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D000068256:Darbepoetin alfa; D007501:Iron