title: Low-dose erythropoietin treatment is not associated with clinical benefits in severely anaemic Jehovah's Witnesses: a plea for a change.
abstract: Jehovah's Witnesses who refuse blood transfusion have high mortality. Erythropoietin (EPO) has been used as an alternative to blood transfusion. The optimal dosing of EPO in anaemic Jehovah's Witnesses is unknown. The aim of our study was to evaluate the clinical benefits of treatment with a low dose (<600 IU/kg/week) of epoietin beta (EPO-β).
  
  
  
  This was an observational study, retrospectively considering a 10-year period during which 3,529 adult Jehovah's Witnesses with a total of 10,786 hospital admissions were identified from databases of four major public hospitals in New Zealand. Patients with severe symptomatic anaemia (haemoglobin <80 g/L) who were unable to tolerate physical activity were included in the study. Patients treated without EPO were assigned to the conventional therapy group and those treated with EPO to the EPO treatment group.
  
  
  
  Ninety-one Jehovah's Witnesses met the eligibility criteria. Propensity score matching yielded a total of 57 patients. Patients treated with conventional therapy and those treated with EPO had similar durations of severe anaemia (average difference 6.25 days, 95% confidence interval [CI]: -3.77-16.27 days; p=0.221). The mortality rate among Jehovah's Witnesses treated with conventional therapy was 4.68 per year (95% CI: 2.23-9.82), while that in those treated with EPO was 2.77 per year (95% CI: 0.89-8.60). Treatment with EPO was associated with a mortality ratio of 0.59 (95% CI: 0.1-2.6; p=0.236). Both groups of patients had similar in-hospital survival (p=0.703).
  
  
  
  Treatment with low-dose EPO-β was not associated with either shorter duration of severe anaemia or a reduction in mortality.
authors.affiliation: Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, University of Auckland, Auckland, New Zealand.
authors.forename: Andrei M
authors.initials: AM
authors.lastname: Beliaev
authors.affiliation: Cardiothoracic and Vascular Intensive Care Unit and Department of Anaesthesia, Auckland City Hospital, University of Auckland, Auckland, New Zealand.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Allen
authors.affiliation: Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, University of Auckland, Auckland, New Zealand.
authors.forename: Paget
authors.initials: P
authors.lastname: Milsom
authors.affiliation: Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, University of Auckland, Auckland, New Zealand.
authors.forename: Parma
authors.initials: P
authors.lastname: Nand
authors.affiliation: Cardiology Department, Auckland City Hospital, University of Auckland, Auckland, New Zealand.
authors.forename: Warren M
authors.initials: WM
authors.lastname: Smith
authors.affiliation: Anatomy with Medical Imaging, University of Auckland, Auckland, New Zealand.
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Bergin
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D016208:Databases, Factual; D018572:Disease-Free Survival; D004921:Erythropoietin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: C554270:EPO protein, human; D004921:Erythropoietin