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The use of blood conservation methods in addition to erythropoietin allows myeloablative allogeneic stem cell transplantation without the use of blood products

Bone Marrow Transplantation volume 37, pages 325–327 (2006)Cite this article

Allogeneic hematopoietic stem cell transplantation (AHSCT) in Jehovah's Witness patients is a challenging procedure1, 2 because they do not accept transfusion of any blood products, as prohibited by their religious beliefs. Several supportive methods have been employed to limit the life-threatening anemia in these patients, like the use of recombinant human erythropoietin (rHuEpo) prior to conditioning chemotherapy in an attempt to raise the hemoglobin (Hgb) and hematocrit (HCT) levels3 or the use of blood conservation methods to minimize blood loss. Both techniques have been used in autologous transplantation4 but experience with allogeneic stem cell transplantation is very limited.

A 44-years-old Jehovah's Witness female patient was diagnosed with chronic phase, chronic myelogenous leukemia (CML) with t(9;22) in August 2002. She was initially treated with hydroxyurea then continued on imatinib mesylate 600 mg daily. The patient achieved hematologic but not cytogenetic remission. After 42 months she progressed to accelerated phase when she was found to have a new chromosomal abnormality, inv (13q) and was referred for AHSCT. At 3 weeks prior to conditioning chemotherapy, the patient was started on epoietin alfa 40 000 units once weekly. Subsequently, she received one dose of darbepoetin 200 mcg. Hgb and HCT values were 10.3 g/dl and 31.0%, respectively, at the beginning of erythropoietin therapy which rapidly normalized after the first two doses. In addition, methods previously used for ‘bloodless’ autologous stem cell transplantation4 were used for the first time in an allogeneic transplant setting. These were: (1) pediatric tubes for blood draws, (2) decreased frequency (CBC, chemistry) to every other day, liver function tests twice weekly, PT/PTT once weekly, (3) closed system return of the waste blood after blood draws, (4) gastrointestinal prophylaxis with proton pump inhibitor, (5) folic acid and iron supplementation daily, vitamin K once weekly, (6) aminocaproic acid for platelet count below 30 000/μl. (7) oxygen support for Hgb <9 g/dl or symptomatic anemia was not required, and (8) oral contraceptives were not used because she had hysterectomy.

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Authors and Affiliations

  1. Department of Medicine, Division of Hematology-Oncology, University of Illinois at Chicago, Chicago, IL, USA

    S Ciurea, L Dobogai, S Chunduri, N Mahmud, D Rondelli & D Peace

  2. Department of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA

    R Beri

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Ciurea, S., Beri, R., Dobogai, L. et al. The use of blood conservation methods in addition to erythropoietin allows myeloablative allogeneic stem cell transplantation without the use of blood products. Bone Marrow Transplant 37, 325–327 (2006). https://doi.org/10.1038/sj.bmt.1705223

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