Anemia Management in a Jehovah's Witness Patient With Hip Fracture

Jehovah's Witnesses are a religious group whose beliefs regarding blood transfusion may pose important clinical and ethical challenges. As such, more patients refuse whole-blood transfusions. Patients with hip fractures often present with anemia, which increases the likelihood of requiring perioperative blood transfusion and increases morbidity and mortality after surgery. We present here the case report of an 80-year-old female patient, a Jehovah's Witness, with no previous history of thromboembolic events. She was admitted due to a right hip fracture after a fall from a standing height. She revealed pain mobilizing the right lower limb, with external rotation and shortness of the limb. Radiological exams showed a right femoral neck fracture. Lab analysis showed iron deficiency anemia (hemoglobin (Hb) 7.2 g/dL, normocytic and normochromic, serum iron 54.9 µg/dL, ferritin 146 ng/mL, and transferrin saturation (TSAT) 17%; serum folate 5.6 ng/mL and vitamin B12 1229 pg/mL). The patient was treated with intravenous iron supplementation, folic acid, and epoetin beta (30,000 IU twice weekly), to reach a goal of Hb 10 g/dL. One month after the initial trauma, the patient presented with Hb 11 g/dL and hematocrit 33.2% and underwent hip surgery. On post-surgery day 1, Hb decreased to 8.1 g/dL, hematocrit 24.5%, serum iron 68 µg/dL, ferritin 781 ng/mL, and TSAT 27%, with no blood transfusion needed afterward. One more epoetin beta administration was performed in the immediate postoperative period. The patient experienced a positive clinical and analytical evolution with progressive improvement in physical function and Hb levels above 11 g/dL. The treatment strategy effectively enabled hip fracture surgery in this patient, improving the patient's outcomes without any postoperative safety issues.