A case study of an older adult with severe anemia refusing blood transfusion

C. Michelle Thomas, Harriet R. Coleman, Leslie Faith Morritt Taub

Research output: Contribution to journalArticlepeer-review


Purpose: To discuss the diagnosis and treatment of severe anemia in an older adult who presents the challenge of declining blood transfusion in a real-world scenario where critical thinking, evidence-based care, and collaboration with other providers must come together to serve this patient's unique needs. Data sources: Extensive review of the scientific literature on anemia and the situation in which a patient refuses blood transfusion presented in a case study format. Conclusions: A thorough physical assessment, complete health history, and appropriate diagnostic workup should be used to distinguish the normal effects of senescence from the signs and symptoms of anemia. Common conditions that cause anemia in the elderly include chronic disease, iron deficiency, and gastro-intestinal bleeding. These conditions may result in profound anemia. The challenge can be compounded when, because of religious tenets, a patient, does not accept a blood transfusion. This case study challenges nurse practitioners to apply knowledge, seek guidance, and make appropriate referrals to care for a patient in order to render care within the parameters of the patient's belief system. Implications for practice: The astute primary care provider recognizes that anemia is not an expected physiological change associated with aging but a manifestation of an underlying disease process. Fatigue, weakness, and dyspnea are all symptoms of anemia that, may be overlooked and attributed to the aging process. Further, in keeping with the principles of autonomy and self-determination, it. is the clinician's duty to work with all patients to restore them to a state of optimal health while respecting deeply held, spiritual beliefs.

Original languageEnglish (US)
Pages (from-to)43-48
Number of pages6
JournalJournal of the American Academy of Nurse Practitioners
Issue number1
StatePublished - Jan 2007


  • Anemia
  • Blood management
  • Iron deficiency
  • Jehovah's witness

ASJC Scopus subject areas

  • General Nursing


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