No Bad Blood — Surviving Severe Anemia Without Transfusion

A51-year-old female Jehovah’s Witness with a history of uterine fibroids traveled from her home country of Colombia to the US for a 2-month visit to assist her daughter in caring for her newborn baby. Soon after arriving in the US, she experienced heavy vaginal bleeding that continued for 2 weeks. She developed dyspnea with exertion, chest pain, and fatigue. She went to an urgent care center for evaluation and was found to have a hemoglobin level of 4.6 g/dL (range, 11.0-14.5 g/dL; to convert to g/L, multiply by 10.0); she was then referred to a local hospital for further care. The patient recalled that on a recent laboratory test, her hemoglobin level was 14 g/dL.

The patient, who speaks no English, described through an interpreter her reaction upon learning that she required hospitalization in the US.

The risk of marginalization is increased for individuals like the patient described previously, who did not have the advantage of communicating with her medical team in her native language. This patient experienced 2 extremes of care: in her home country and in the US, one physician offered no alternative to blood transfusion, and another chastised her for choosing bloodless medicine care. In this patient’s case, a multidisciplinary and patient-centered approach to care resulted in a favorable medical and psychological outcome for both the patient and the care team.

Physicians who accept the challenges of learning how to treat patients safely and successfully without the traditional safety net of blood transfusion may experience a new level of confidence and expanded opportunities for providing quality care for all patients. Use of this approach can enhance patient care and avoid “bad blood” in the medical care of Jehovah’s Witnesses.