Successful Management of Thrombotic Thrombocytopenic Purpura in a Jehovah's Witness: An Individualized Approach With Joint Decision-Making

Journal of Patient Experience
Ming Y Lim, Charles S Greenberg

Abstract

The management of thrombotic thrombocytopenic purpura (TTP) presents a unique challenge in individuals who are unable to accept plasma due to religious beliefs, given that therapeutic plasma exchange (TPE) is the standard of care. A 61-year-old Jehovah's Witness woman presented to our hospital with neurological symptoms and laboratory findings suggestive of TTP. On admission, she refused transfusion of blood products, specifically red blood cells, platelets, and plasma but accepted albumin and intravenous immunoglobulin (IVIG); fractions of plasma. She was started on steroids, IVIG, and TPE with albumin as replacement therapy with minimal improvement. After a detailed discussion with the patient and family, they agreed to accept cryosupernatant. The patient started TPE with cryosupernatant for replacement therapy, which resulted in clinical improvement. This case highlights the importance of an individualized approach with joint decision-making given the significant heterogeneity that exists in Jehovah's Witnesses' attitude toward the receipt of blood products.

References

Apr 20, 2001·Journal of Clinical Apheresis·Z R ZeiglerUNKNOWN North American TTP Group
Feb 3, 2007·American Journal of Hematology·Michael G MartinGowthami M Arepally
Sep 8, 2011·Asian Journal of Transfusion Science·Sandeep S WaliaHarpreet S Walia
Nov 7, 2012·Journal of Pediatric Hematology/oncology·Swati Naik, Donald H Mahoney
Jul 3, 2013·American Journal of Hematology·Flora PeyvandiAnastassios D Retzios
May 2, 2014·Journal of Clinical Apheresis·Wanxing ChaiArthur P Rabinowitz
Oct 8, 2015·Obstetrics and Gynecology·Richard HubbardMark H Yazer
Aug 1, 2016·Journal of Clinical Apheresis·Christopher J PatriquinUNKNOWN Canadian Apheresis Group
Apr 19, 2017·Blood·Bérangère S JolyAgnès Veyradier

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Citations

Sep 12, 2020·Journal of Thrombosis and Haemostasis : JTH·X Long ZhengFlora Peyvandi
Feb 6, 2021·Journal of Clinical Medicine·Senthil SukumarSpero R Cataland
Mar 15, 2021·Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis·César David Galindo-CalvilloDavid Gómez-Almaguer

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