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Management of the Severely Anemic Jehovah's Witness
- Marianne Mann, MD;
- John J. Votto, MD; and
- Joseph Kambe, MD
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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 In fact, the Food and Drug Administration has not chosen to approve this drug and it has been withdrawn from the market.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
