Ramadan fasting and hematological disorders: clinical considerations, risks, and management strategies

Ramadan fasting induces significant physiological adaptations that can affect patients with hematological disorders. While fasting is generally safe for healthy individuals, reduced hydration and nutritional intake during the 13-18 hour fasting period can pose risks for those with anemia, coagulopathies, or malignancies. High-risk patients - such as those on intensive chemotherapy, post stem-cell transplantation, or with severe anemia (hemoglobin <8 g/dL) - are advised not to fast to avoid complications (e.g. vaso-occlusive crises, thrombotic events, or worsening anemia). Patients with stable hematologic conditions, however, may fast safely with careful pre-Ramadan evaluation, medication timing adjustments, and strict hydration and nutrition plans. Given the limited clinical data, an individualized risk stratification approach is essential. Shared decision-making, balancing religious aspirations with medical safety, is encouraged. Future studies are needed to establish evidence-based guidelines, but until then, thorough risk assessment, proactive monitoring, and patient education form the cornerstone of safe Ramadan fasting for individuals with hematological disorders.