S4639 You Cannot Give Blood, What's Next in GI Bleed: A Case Series of GI Bleed in Jehovah's Witness

Introduction: Gastrointestinal (GI) bleeding is a life-threatening entity where we frequently utilize blood products as part of the treatment. Jehovah’s Witness (JW) has an estimated 8.5 million followers worldwide and they decline transfusion of blood products. GI bleed generates profound perfusion deficits and JW patients require special measures to increase chances of a successful outcome. We are reporting 3 cases of JW patients with GI bleed with favorable outcome. Case Description/Methods: Case 1: A 64-year-old woman with past medical history (PMH) of hiatal hernia, Cameron lesions presented to hospital with lightheadedness and an episode of melanotic stool. Her initial hemoglobin (Hb) was 6.3. As she was a JW, she was treated with Erythropoietin (EPO) 40,000 units for 3 days. She was given crystalloid boluses to maintain blood pressure. Furthermore, she was supplemented with daily vitamin C, B12, folic acid tablets, and IV iron. On day 3 Hb improved to 7.2 without any further bleeding. Case 2: A 66-year-old man with PMH of gastroesophageal reflux disease (GERD), diabetes, hypertension presented with fatigue and melena for 2 weeks. Hb on presentation was 7.1 which fell to 6.5. Being a JW patient was treated with high dose EPO, IV iron and vitamins. Esophagogastroduodenoscopy (EGD) and colonoscopy showed no active bleed. His Hb improved 7.3 by day 8. Case 3: A 48-year-old man with PMH of hypertension, and hemorrhoids presented to us after having hematochezia. His hemoglobin dropped sharply from 12.4 to 6.5. while being hypotensive. Crystalloids and EPO were given. Hemostasis was achieved via EGD. His Hb increased to 7.1 by day 4. Discussion: Erythropoietin (EPO) is a hormone that stimulates red blood cell production. Its efficacy is well established in renal failure patients, but literature shows potential benefits in non-renal failure cases too. High-dose EPO has shown particular benefit in active bleeding, with 1 RCT demonstrating a 50% reduction in intensive care unit transfusion needs. The hemoglobin rise varies by patient, but on average, a 1.44 g/dL increase is expected within a week. Supplementing with iron and vitamins enhances this effect. Regular monitoring for thrombosis via venous duplex is advised. While optimal EPO dosing in Jehovah’s Witnesses (JW) lacks clear data, high-dose regimens have shown promise in overcoming EPO resistance in inflammation-driven anemia. As medicine evolves to be more inclusive, further research in JW is needed to improve patient-centered outcomes.