REPLY
Management of the Severely Anemic Jehovah's Witness
Marianne Mann;
John J. Votto; and
Joseph Kambe
15 July 1993 | Volume 119 Issue 2 | Pages 169-170
IN RESPONSE:
We appreciate the comments of Drs. Auerbach and Ballard regarding the use of intravenous iron dextran as a total dose infusion.
Dr. Green's statement that "albumin is considered acceptable by the Church" is incorrect. The Church leaves this decision up to the individual based on the precedent that it passes freely between mother and fetus, as per our discussion with a Watchtower spokesperson in New York.
Drs. Youn and Burns correctly point out that hyperbaric oxygen therapy has been used in severely anemic patients who refuse blood transfusion. Hart and colleagues' review [1] of 26 patients treated with hyperbaric oxygen, however, also mentions a 50% incidence of barotrauma, which was felt to reflect the number of treatments per day. A prospective study would offer more information about the potential benefit and risk of this expensive therapy in patients with severe anemia.
Dr. Haq brings up an interesting drug, aprotinin, which has been used and reported on mostly in Europe. We agree that the antifibrinolytic effects and platelet preservation properties of this drug might be of value in patients with extensive hemorrhage or disseminated intravascular coagulation. It is such a good antifibrinolytic agent, however, that clot has been reported on pulmonary artery catheters [2]. It is incompatible with corticosteroids, heparin, and the protein and lipid content of hyperalimentation. In fact, the Food and Drug Administration has not chosen to approve this drug and it has been withdrawn from the market.
1. Hart G, Lennon P, Struiss M. Hyperbaric oxygen in exceptional acute blood loss anemia. J Hyperbaric Med. 1987; 2:205-10.
2. Youngberg JA. Aprotinin and thrombus formation on pulmonary artery catheters: a piece of the coagulation puzzle. J Cardiothorac Anesth. 1990; 4:155-8.
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