Abstract
The refusal of Jehovah's Witnesses with leukaemia to accept transfusion provides a major clinical challenge because of the myelosuppressive effects of chemotherapy. Experience in treating five such patients is described. Two patients with acute lymphoblastic leukaemia (ALL) achieved remission following chemotherapy, the first without transfusion support, the second, a minor, receiving transfusion under a court order: the first patient remains in remission 5 years later, whereas the second subsequently relapsed and died. Of three patients with acute myeloid leukaemia (AML), two received chemotherapy: one died of anaemia during induction chemotherapy whereas the second eventually consented to transfusion but died of refractory leukaemia. The third patient died of anaemia despite erythropoietin. We feel Jehovah's Witnesses should not be denied antileukaemic therapy if they fully understand the risks involved. Minimizing phlebotomy, use of antifibrinolytic agents and growth factors may make chemotherapy feasible, especially in ALL where remission may be induced with less myelosuppressive agents. The outlook for those with AML treated with conventional chemotherapy appears poor; alternative approaches to treatment should be consider...Continue Reading
References
Jan 1, 1992·Medical and Pediatric Oncology. Supplement·R Blütters-Sawatzki, U Bertram
Dec 15, 1992·Annals of Internal Medicine·M C MannM J McNamee
Jun 1, 1992·American Journal of Hematology·P M DainerG P Sartiano
Sep 1, 1990·Lancet·L SaltuariM Jeschow
Sep 1, 1990·Lancet·J B HargisJ Redmond
Jun 1, 1991·British Journal of Haematology·O B EdenJ Peto
Mar 15, 1990·The New England Journal of Medicine·S L GoldbergG P Schechter
Mar 15, 1985·Hospital Practice·D R Boggs
Sep 1, 1989·Archives of Internal Medicine·J R BartholomewW R Bell
Mar 1, 1988·British Journal of Haematology·C F HoyleF G Hayhoe
Apr 1, 1985·British Journal of Haematology·R T PerriM M Oken
Nov 1, 1985·Scandinavian Journal of Haematology·H S Garewal, B G Durie
Jul 1, 1995·American Journal of Hematology·S Couban, W E Wilson
Oct 28, 1995·BMJ : British Medical Journal·D Busuttil, A Copplestone
Jan 1, 1994·Acta Haematologica·S KojimaY Kodera
Jun 1, 1994·The American Journal of Medicine·I Kleinman
Jun 1, 1993·American Journal of Hematology·T NousiainenR Lahtinen
Jul 1, 1996·British Journal of Haematology·J K ReesK Wheatley
Feb 6, 1997·The New England Journal of Medicine·M FanucchiL Harker
Citations
Feb 13, 2001·British Journal of Haematology·G A KennedyD Gill
Oct 3, 2002·British Journal of Haematology·Judith C W Marsh, David H Bevan
Oct 12, 2002·Transfusion·Jeffrey L CarsonSteven A Gould
Jun 15, 2007·International Journal of Hematology·Shinya FujisawaMasahide Kobayashi
Apr 10, 2008·Leukemia & Lymphoma·Nicole M BrownPatricia A Ford
Oct 6, 2005·Transfusion Medicine·D BarefordS Wiltshire
May 20, 2003·British Journal of Haematology·C J BartonD Mabin
Apr 20, 2004·European Journal of Haematology·Daniele LaszloGiovanni Martinelli
Apr 12, 2016·Pharmaceuticals·Ashkan EmadiZeba Singh
Mar 14, 2014·Journal of Chemotherapy·Louise ZhouTroy Guthrie
Nov 6, 2014·Case Reports in Hematology·Yumi YamamotoKiyoyuki Ogata
Mar 26, 2002·Leukemia & Lymphoma·J MurdockP McNamee
Dec 8, 2017·Hematology·Stefan Wilop, Rainhardt Osieka
Aug 6, 2003·Bone Marrow Transplantation·P MazzaG Pricolo
Feb 19, 2019·Leukemia & Lymphoma·Louis PerolJerome Tamburini
May 12, 2010·Transfusion·Laura L DonahueGerson Greenburg
Aug 20, 2002·The Oncologist·Kristine A KnutiRichard T Penson
Feb 3, 1999·American Journal of Hematology·S TakeuchiA Nakashima
Jul 8, 2016·Transfusion·Krzysztof ChojnowskiJacek Treliński
May 20, 2015·Clinical Case Reports·Hege GareliusDick Stockelberg
Nov 7, 2019·British Journal of Haematology·Firas El Chaer, Karen K Ballen
Aug 9, 2018·Annals of Hematology·Rory M ShallisAmer M Zeidan
Mar 29, 2000·Pediatric Hematology and Oncology·U KohderaY Kobayashi
Dec 21, 2018·BMJ Case Reports·Nivedita AroraNavid Sadeghi