Assuntos
Vírus da Dengue , Dengue , Encefalite Viral , Transplante de Células-Tronco Hematopoéticas , Transtornos Mieloproliferativos , Idoso , Aloenxertos , Dengue/sangue , Dengue/etiologia , Dengue/terapia , Encefalite Viral/sangue , Encefalite Viral/etiologia , Humanos , Masculino , Transtornos Mieloproliferativos/sangue , Transtornos Mieloproliferativos/terapiaRESUMO
BACKGROUND: There is no standard treatment for patients with severe anemia who refuse blood transfusion or cannot receive red blood cells. CASE REPORT: After 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. RESULTS: The 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. CONCLUSION: This 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.