Management of anemia in patients who decline blood transfusion

Aryeh Shander, Lawrence Tim Goodnough

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Declining a treatment modality should not be considered the same as refusal of medical care as illustrated by the management of Jehovah's Witness patients who do not accept transfusions. Over the years, a comprehensive set of strategies have been developed to meet the specific needs of these patients and these strategies are collectively called “Bloodless Medicine and Surgery” (BMS). The focus in BMS is to optimize the patients' hematopoietic capacity to increase hemoglobin (Hgb) level, minimize blood loss, improve hemostasis, and provide supportive strategies to minimize oxygen consumption and maximize oxygen utilization. We present 3 case reports that illustrate some of the challenges faced and measures available to effectively treat these patients. Under BMS programs, patients with extremely low hemoglobin levels, not conducive to survival under ordinary conditions, have survived and recovered without receiving allogeneic transfusions. Additionally, the valuable experience gained from caring for these patients has paved the way to develop the concept of Patient Blood Management as a standard care to benefit all patients, and not only those for whom blood is not an option.

Original languageEnglish
Pages (from-to)1183-1191
Number of pages9
JournalAmerican Journal of Hematology
Issue number9
StatePublished - Sep 2018
Externally publishedYes


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