| Abstract | Acute lymphoblastic leukemia (ALL) is a common hematological malignancy, which requires intensive chemotherapy, followed by allogeneic hematopoietic stem cell transplant in adults or a 2-3 year treatment in pediatric patients. However, aggressive blood transfusion is always unavoidable either at initial presentation, during intensive chemotherapy or peri-transplantation period. Jehovah’s Witness are well known for the door-to-door preaching and refusing blood transfusions. How to manage a patient of ALL and also Jehovah’sWitness is challenging. Here, we described a 19-year-old male with early T precursor acute lymphoblastic leukemia, who refused to receive blood transfusion as being Jehovah’s Witness. The initial blood count revealed WBC count 110,740/ul (segments 1.5%, lymphocytes 3%, atypical lymphocyte 88.5%, and blasts 5%), hemoglobin 12.4 g/dL, and platelets 239k /ul. By aggressive nutrition support with folic acid and vitamin B12, combined with the usage of hematopoietic growth factors, he completed the induction, consolidation and reinduction chemotherapy of pediatric type treatment without receiving any transfusion. During which, the lowest level of hemoglobin and platelet were 7.6 g/dl and 5k /ul, respectively. Currently, he received weekly maintenance chemotherapy at our clinic and bone marrow MRD was less than 0.01%. We believe the supportive measures may also benefit other patients of hematological malignancies by reducing transfusion frequency and transfusion-associated adverse effects. Policy of blood component usage and feasibility of stem cell transplantation in patients of Jehovah’s Witness were also reviewed. |
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