losartan-potassium and Menorrhagia

For reasons of religious belief, Jehova's Witnesses do not accept blood transfusions or the infusion of blood products. In situations in which severe, life-threatening anemia develops, patient refusal to receive a transfusion can create serious ethical and legal problems. The principle of patient autonomy, which implies the freedom to accept or reject treatment, comes into conflict with the physician's obligation to safeguard the patient's life using all means possible. We report 2 cases of severe anemia in Jehova's Witnesses. One was due to menorrhagia and the other to postpartum bleeding. The physician should be aware of alternatives to infusion of blood products and know how to cope with an unexpected critical event in these patients. The measures we took were effective in our patients. In the case of menorrhagia, hormone treatment is effective when the woman wishes to preserve the ability to conceive and avoid surgery (endometrial ablation and hysterectomy). In postpartum bleeding refractory to conservative treatment, selective embolization of bleeding vessels may make it unnecessary to resort to more aggressive treatment, such as obstetric hysterectomy.

Topics: Adult; Anemia; Anti-Anxiety Agents; Anticoagulants; Cervix Uteri; Combined Modality Therapy; Contraceptives, Oral, Hormonal; Dalteparin; Embolization, Therapeutic; Erythropoietin; Female; Ferric Compounds; Ferric Oxide, Saccharated; Glucaric Acid; Humans; Immobilization; Jehovah's Witnesses; Menorrhagia; Oxygen Inhalation Therapy; Parenteral Nutrition; Postpartum Hemorrhage; Pregnancy; Recombinant Proteins; Thromboembolism; Treatment Refusal; Young Adult

To investigate whether postoperative administration of erythropoietin can safely augment in the rapid restoration of hemoglobin (Hgb) values following major gynecologic surgery.. Thirty-three women were enrolled. They had all undergone gynecologic surgery due to malignant or non-malignant reasons. Because of chronic blood loss, many of these patients were iron depleted. Examinations of hematology, serum chemistry and urinalysis values were obtained. Subcutaneous administration of r-HuEPO, in a dosage of 40,000 IU was initiated on the first postoperative day. One additional injection of 40,000 IU was given on the fourth day after surgery. Contemporarily the patients received orally a polysaccharide-iron complex.. During the early postoperative period three patients that were transfused due to severe anemia and one more that was lost in follow-up were excluded from the study analysis. The remaining 29 patients showed a considerable rise in Hgb counts that reached a median value of 1.9 g/dl within a 20-day period.. The postoperative administration of r-HuEPO in gynecologic surgery in patients where autologous blood transfusions can be avoided is challenging, since it can guarantee an uneventful postoperative period with rapid resuscitation without posing the patient to the well-established risks of transfusions.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Blood Loss, Surgical; Drug Administration Schedule; Erythrocyte Transfusion; Erythropoietin; Female; Ferric Compounds; Greece; Gynecologic Surgical Procedures; Hemoglobins; Humans; Injections, Subcutaneous; Menorrhagia; Middle Aged; Polysaccharides; Postoperative Care; Prospective Studies; Recombinant Proteins

Topics: Adult; Blood Transfusion; Drug Administration Schedule; Erythropoietin; Female; Hemoglobinometry; Humans; Hysterectomy; Injections, Subcutaneous; Menorrhagia; Pilot Projects; Premedication; Recombinant Proteins