Severe Acute Anemia After Liver Transplantation in an Elderly Jehovah's Witness Treated With High-dose Erythropoietin and Ferric Carboxymaltose: A Case Report

• An elderly Jehovah's witness presented with severe acute anemia with hemorrhagic shock after liver transplantation.
• The calculated red blood cell loss was near 70%.
• The patient was treated with high-dose erythropoietin and ferric carboxymaltose.
• The association of these drugs may be an option for patients with severe anemia who refuse blood transfusion or who cannot receive red blood cells.

BackgroundThere is no standard treatment for patients with severe anemia who refuse blood transfusion or cannot receive red blood cells.Case reportAfter an orthotopic liver transplantation, an elderly Jehovah's Witness who refused blood transfusion presented with severe acute anemia with hemorrhagic shock. The calculated red blood cell loss was near 70%. Associated with surgical treatment and supportive measures, the patient was treated with high-dose erythropoietin and ferric carboxymaltose.ResultsThe patient presented a rapid increase in hemoglobin concentration and reticulocyte count with resolution of hemorrhagic shock after the proposed pharmacologic treatment combined with local hemostatic measures. She was transferred to a low-risk unit 4 days after transplantation and was discharged from the hospital on day 10. The hemoglobin concentration was normal 35 days after the bleeding event.ConclusionThis case demonstrated that a protocol with high-dose erythropoietin and ferric carboxymaltose may be an option for patients with severe anemia who refuse blood transfusion or cannot receive red blood cells.