DOI QR코드

DOI QR Code

Recombinant Human Erythropoietin Therapy for a Jehovah's Witness Child With Severe Anemia due to Hemolytic-Uremic Syndrome

  • Woo, Da Eun (Department of Pediatrics, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Lee, Jae Min (Department of Pediatrics, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Kim, Yu Kyung (Department of Laboratory Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Park, Yong Hoon (Department of Pediatrics, Yeungnam University Medical Center, Yeungnam University College of Medicine)
  • Received : 2014.09.04
  • Accepted : 2014.10.20
  • Published : 2016.02.15

Abstract

Patients with hemolytic-uremic syndrome (HUS) can rapidly develop profound anemia as the disease progresses, as a consequence of red blood cell (RBC) hemolysis and inadequate erythropoietin synthesis. Therefore, RBC transfusion should be considered in HUS patients with severe anemia to avoid cardiac or pulmonary complications. Most patients who are Jehovah's Witnesses refuse blood transfusion, even in the face of life-threatening medical conditions due to their religious convictions. These patients require management alternatives to blood transfusions. Erythropoietin is a glycopeptide that enhances endogenous erythropoiesis in the bone marrow. With the availability of recombinant human erythropoietin (rHuEPO), several authors have reported its successful use in patients refusing blood transfusion. However, the optimal dose and duration of treatment with rHuEPO are not established. We report a case of a 2-year-old boy with diarrhea-associated HUS whose family members are Jehovah's Witnesses. He had severe anemia with acute kidney injury. His lowest hemoglobin level was 3.6 g/dL, but his parents refused treatment with packed RBC transfusion due to their religious beliefs. Therefore, we treated him with high-dose rHuEPO (300 IU/kg/day) as well as folic acid, vitamin B12, and intravenous iron. The hemoglobin level increased steadily to 7.4 g/dL after 10 days of treatment and his renal function improved without any complications. To our knowledge, this is the first case of successful rHuEPO treatment in a Jehovah's Witness child with severe anemia due to HUS.

Keywords

References

  1. Scheiring J, Rosales A, Zimmerhackl LB. Clinical practice. Today's understanding of the haemolytic uraemic syndrome. Eur J Pediatr 2010;169:7-13. https://doi.org/10.1007/s00431-009-1039-4
  2. Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet 2005;365:1073-86.
  3. Exeni R, Donato H, Rendo P, Antonuccio M, Rapetti MC, Grimoldi I, et al. Low levels of serum erythropoietin in children with endemic hemolytic uremic syndrome. Pediatr Nephrol 1998;12:226-30. https://doi.org/10.1007/s004670050443
  4. Brandt JR, Fouser LS, Watkins SL, Zelikovic I, Tarr PI, Nazar-Stewart V, et al. Escherichia coli O 157:H7-associated hemolyticuremic syndrome after ingestion of contaminated hamburgers. J Pediatr 1994;125:519-26. https://doi.org/10.1016/S0022-3476(94)70002-8
  5. Ake JA, Jelacic S, Ciol MA, Watkins SL, Murray KF, Christie DL, et al. Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion. Pediatrics 2005;115:e673-80. https://doi.org/10.1542/peds.2004-2236
  6. Weil BR, Andreoli SP, Billmire DF. Bleeding risk for surgical dialysis procedures in children with hemolytic uremic syndrome. Pediatr Nephrol 2010;25:1693-8. https://doi.org/10.1007/s00467-010-1530-1
  7. Trachtman H, Christen E. Pathogenesis, treatment, and therapeutic trials in hemolytic uremic syndrome. Curr Opin Pediatr 1999;11:162-8. https://doi.org/10.1097/00008480-199904000-00011
  8. Remmers PA, Speer AJ. Clinical strategies in the medical care of Jehovah's Witnesses. Am J Med 2006;119:1013-8. https://doi.org/10.1016/j.amjmed.2006.04.016
  9. Donahue LL, Shapira I, Shander A, Kolitz J, Allen S, Greenburg G. Management of acute anemia in a Jehovah's Witness patient with acute lymphoblastic leukemia with polymerized bovine hemoglobin- based oxygen carrier: a case report and review of literature. Transfusion 2010;50:1561-7. https://doi.org/10.1111/j.1537-2995.2010.02603.x
  10. Feagan BG, Wong CJ, Kirkley A, Johnston DW, Smith FC, Whitsitt P, et al. Erythropoietin with iron supplementation to prevent allogeneic blood transfusion in total hip joint arthroplasty. A randomized, controlled trial. Ann Intern Med 2000;133:845-54. https://doi.org/10.7326/0003-4819-133-11-200012050-00008
  11. Digieri LA, Pistelli IP, de Carvalho CE. The care of a child with multiple trauma and severe anemia who was a Jehovah's Witness. Hematology 2006;11:187-91. https://doi.org/10.1080/10245330600774942
  12. Akingbola OA, Custer JR, Bunchman TE, Sedman AB. Management of severe anemia without transfusion in a pediatric Jehovah's Witness patient. Crit Care Med 1994;22:524-8. https://doi.org/10.1097/00003246-199403000-00025
  13. Bahlmann FH, Fliser D. Erythropoietin and renoprotection. Curr Opin Nephrol Hypertens 2009;18:15-20. https://doi.org/10.1097/MNH.0b013e32831a9dde
  14. Pape L, Ahlenstiel T, Kreuzer M, Drube J, Froede K, Franke D, et al. Early erythropoietin reduced the need for red blood cell transfusion in childhood hemolytic uremic syndrome: a randomized prospective pilot trial. Pediatr Nephrol 2009;24:1061-4. https://doi.org/10.1007/s00467-008-1087-4
  15. Balestracci A, Martin SM, Toledo I, Alvarado C, Wainsztein RE. Early erythropoietin in post-diarrheal hemolytic uremic syndrome: a case-control study. Pediatr Nephrol 2015;30:339-44. https://doi.org/10.1007/s00467-014-2911-7

Cited by

  1. Refusal of blood transfusion by a hemodialysis patient with renal anemia for religious reasons vol.51, pp.6, 2016, https://doi.org/10.4009/jsdt.51.409