Case Presentation: 42-year-old Jehovah’s Witness female with history of uterine fibroids, PCOS, anxiety who initially presented to the emergency department with new small spots on her arms and legs found to have a platelet count of 2x 10E3/uL. She was diagnosed with ITP at the time she was hemodynamically stable and agreed to close follow-up and monitoring. Thus, she was discharged on 1 mg/kg of prednisolone with plans to follow-up with hematology outpatient. Two days later, she presented to the emergency department with severe menorrhagia. She began soaking through sanitary napkins every hour. Her platelet count was found to be 1x10E3/uL and her hemoglobin was 10.0 G/DL. She was initially treated with high dose steroids but declined any traditional blood products including pharmaceutical grade blood products such as immunoglobulins. Her hemoglobin down trended, reaching 5.9 G/DL at its lowest. After discussing with family and support group, the patient decided that as long as she did not receive any of the 4 whole blood components (RBCs, WBCs, platelets, plasma) she would be agreeable to receiving IVIG treatment. The patient was given a total of 4 doses of IVIG in addition to high-dose steroids with improvement in her platelet count. She was started on PJP prophylaxis while on high-dose steroids and was also given 1 g of INFeD in a short duration of Procrit 40,000 units weekly. Her hemoglobin began to uptrend, and she was discharged from the hospital with close hematology follow-up.
Discussion: Jehovah’s witness patients have special treatment considerations as they traditionally do not accept blood products for religious reasons. However, as in this case, they may be open to receiving products derived from blood such as IVIG and albumin. Providers should be aware that Jehovah’s witness patients may accept products derived from humans, as treatment with these interventions could greatly improve prognosis.
Conclusions: Jehovah’s witnesses are known to reject blood products due to their religious beliefs. Traditionally, they have refused the use of RBCs, WBCs, platelets, and plasma. However, the use of other humanly derived products such as IVIG and albumin is not explicitly prohibited. Treatment with IVIG may be accepted by Jehovah’s witnesses and should be offered when clinically appropriate.