One of Jehovah s Witnesses with Gangrenous Foot and Severe Anemia: A Case Report

Case Report

Austin J Clin Case Rep. 2023; 10(4): 1286.

One of Jehovah’s Witnesses with Gangrenous Foot and Severe Anemia: A Case Report

Ciubara R1*; Severin G2; Darciuc R3; Gotonoaga E3; Savan V4

1Anesthesia and Intensive Care Department, Medpark International Hospital, Chisinau, Republic of Moldova

2Anesthesia and Intensive Care Department, Municipal Clinical Hospital Nr.1 Gheorghe Paladi, Chisinau, Republic of Moldova

3Cardiology Department, Medpark International Hospital, Chisinau, Republic of Moldova

4Cardiovascular and Thoracic Anesthesia and Intensive Care, University Hospital Center Grenoble Alpes, Grenoble, France

*Corresponding author: Ciubara R Anesthesia and Intensive Care Department, Medpark International Hospital, 24 Andrei Doga Street, Chisinau, MD-2024, Republic of Moldova. Tel: +373 79084040 Email: rciubara2@gmail.com

Received: April 24, 2023 Accepted: May 29, 2023 Published: June 05, 2023

Abstract

There are an increasing number of patients who are refusing blood transfusions for several reasons, the most widespread among them being Jehovah’s Witnesses.

We present a case of a 66-year-old woman admited to the hospital with gangrene as a complication of the diabetic foot. The hemoglobin level was 4.8g/dl, hematocrit was 15.8% and mean corpuscular volume was 77.1 fL. She needed urgent surgery to amputate her foot. Being one of Jehovah’s Witnesses, she refused blood transfusions. A multimodal blood management approach was applied, and the patient underwent leg amputation without transfusion of any blood product. The treatment strategy is discussed.

Keywords: Amputation; Anemia; Gangrene; Jehovah’s witnesses; Perfluorocarbon; Case report

Introduction

Jehovah's Witnesses are well known in the medical world for their refusal of accepting blood transfusions. The refusal is based on their understanding of Bible verses like Genesis 9:3-4, Leviticus 17:10-11 and Acts 15:29. They do not accept transfusion of allogenic whole blood, red blood cells, thrombocytes, leukocytes and plasma, do not accept preoperative autologous blood collection and storage for later reinfusion. Accepting some minor components is a matter of a personal decision [1]. In some clinical scenarios the care for a patient who is one of Jehovah's Witnesses could be challenging.

We present a case of a patient with gangrenous foot and severe anemia who underwent leg amputation without any transfusion of blood products. Consent from the patient was obtained to publish the report.

Case Description

A 66-year-old woman who is one of the Jehovah's Witnesses, was admitted in November 2015 to Medpark International Hospital, Chisinau, Republic of Moldova, with a gangrenous foot requiring urgent surgery. She also had poorly controlled type 2 diabetes mellitus under insulin therapy (HbA1C - 9%). The patient was transferred from other hospital because of management problems involving extremely severe anemia (hemoglobin – 4.8g·dL-1) and her refusal of blood products transfusion. Prior to the transfer 200mg intravenous iron sucrose and 8,000 IU of recombinant human erythropoietin (rHuEPO) alfa were administered.

At admission, the patient had signs of well compensated severe anemia (hemoglobin – 5.4g·dL-1, erythrocytes – 2.27x1012·L-1, hematocrit – 17.5%, mean corpuscular volume – 77.1fL, serum iron – 5.8mmol·L-1) with normal lactate level and without tachycardia or ischemic changes on ECG. In addition, the laboratory findings showed leukocytosis - 14.2x109·L-1, increased C reactive protein – 48 g·L-1 and a moderately decreased kidney function (estimated glomerular filtration rate (eGFR) – 52ml·min-1). She received oxygen support, intravenous iron sucrose, folic acid, rHuEPO and vitamin B12 (Figure 1).

Citation: Ciubara R, Severin G, Darciuc R, Gotonoaga E, Savan V. One of Jehovah’s Witnesses with Gangrenous Foot and Severe Anemia: A Case Report. Austin J Clin Case Rep. 2023; 10(4): 1286.