Iron Supplementation and Epoetin Alfa in a Jehovah's Witness with Severe Iron Deficiency Anemia

Abstract

Objective: To report a case of severe iron deficiency anemia (IDA) in a Jehovah's Witness, successfully treated with iron supplementation and epoetin alfa. Case Summary: A 69-year-old African man, a Jehovah's Witness, presented with severe IDA of unknown cause and was admitted to the general medicine service. He was treated with oral and intravenous iron and subcutaneous epoetin alfa. His serum hemoglobin concentration steadily improved. He was discharged to home on epoetin alfa and iron supplementation. His hemoglobin concentration was stable 1 month later. Discussion: Iron is a critical factor in hemoglobin synthesis and erythropoiesis, and iron deficiency is a common cause of anemia. Jehovah's Witnesses with severe anemia pose a challenge to providers because of their refusal to accept blood products. Alternative treatment regimens are few, and little evidence exists to guide treatment decisions. Recombinant human erythropoietin (rHuEpo) may play a role, but little is known about its use in IDA. Most studies on rHuEpo focus on its use in the setting of surgery, burns, trauma, pregnancy, and severe gastrointestinal bleeding. Conclusions: This case demonstrates that rHuEpo plus iron supplementation may be an acceptable alternative to blood transfusion in a Jehovah's Witness patient with severe IDA.