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Case Reports
. 2020 Feb;7(1):8-11.
doi: 10.1177/2374373519829902. Epub 2019 Feb 14.

Successful Management of Thrombotic Thrombocytopenic Purpura in a Jehovah's Witness: An Individualized Approach With Joint Decision-Making

Ming Y Lim  1 , Charles S Greenberg  1
Affiliations
Case Reports

Successful Management of Thrombotic Thrombocytopenic Purpura in a Jehovah's Witness: An Individualized Approach With Joint Decision-Making

Ming Y Lim et al. J Patient Exp. 2020 Feb.

Abstract

The management of thrombotic thrombocytopenic purpura (TTP) presents a unique challenge in individuals who are unable to accept plasma due to religious beliefs, given that therapeutic plasma exchange (TPE) is the standard of care. A 61-year-old Jehovah's Witness woman presented to our hospital with neurological symptoms and laboratory findings suggestive of TTP. On admission, she refused transfusion of blood products, specifically red blood cells, platelets, and plasma but accepted albumin and intravenous immunoglobulin (IVIG); fractions of plasma. She was started on steroids, IVIG, and TPE with albumin as replacement therapy with minimal improvement. After a detailed discussion with the patient and family, they agreed to accept cryosupernatant. The patient started TPE with cryosupernatant for replacement therapy, which resulted in clinical improvement. This case highlights the importance of an individualized approach with joint decision-making given the significant heterogeneity that exists in Jehovah's Witnesses' attitude toward the receipt of blood products.

Keywords: Jehovah’s Witness; cryosupernatant; plasma exchange.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Hemoglobin and platelet response to treatment. The patient received IVIG 1 g/kg on day 2 and 3; plasma exchange with albumin replacement on day 3; rituximab 375 mg/m2 on day 4 and 8; rituximab 100 mg on day 16 and 23; Koate 2000 IU on day 6 and 10; and plasma exchange with cryosupernatant on day 5, 9, 16 to 22. The patient also received methylprednisolone 1000 mg on day 1 to 3, followed by prednisone 1 mg/kg daily; folic acid daily; intravenous iron infusion on day 6 to 12 and recombinant human erythropoietin on day 3, 5, 7, 10, 12, and 14 (not shown in graph above due to space constraints). I, IVIG; A, plasma exchange with albumin replacement; R, rituximab; K, Koate; C, plasma exchange with cryosupernatant. IVIG indicates intravenous immunoglobulin.
See this image and copyright information in PMC

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