With an estimated 6000000 Jehovah’s witnesses worldwide, haematologists may encounter patients who decline blood transfusions as a matter of personal belief.The risks of high-dose chemotherapy include life threatening bleeding from thrombocytopenia and profound anemia. Autologous stem cell transplantation is usually associated with the transfusion of 5 to 20 units of red blood cell or platelets, with the potential side-effects of infectious disease transmission, transfusion reactions, and iron overload. Inabilty ot ransfuse can be accommodates by increasing use of erythropoietin (although this was shown in one study not to change outcomes), minimizing blood collection and blood sparing techniques.
In recent years, several facilites, such as University of Pennsylvania, have extended their bloodles surgery programs into the area of transplantation. However, this remains supported by case reports abd series only. It might be expected that only successful cases are published since a publication bias applies in this situation. It is also likely that some conditions are less suitable to this approach and this, as well as apropriate patietn selection, must be explored in clinical trials.
K K Ballen et al, Case Report Successful autologous bone marrow transplant without the use of blood product support July 2000, Volume 26, Number 2, Pages 227-229
Estrin JT, Ford PA, Henry DH et al. Erythropoietin permits high-dose chemotherapy with peripheral blood stem-cell transplant for a Jehovah’s Witness. Am J Hematol 1997; 55: 51-52
Bone Marrow Transplant. 2008 Feb 4 [Epub ahead of print] Links
SCT in Jehovah’s Witnesses: the bloodless transplant.Sloan JM, Ballen K..