Management of Acute GI Bleeding in Patients Who Refuse Blood or

Background and Significance: The Gastroenterology consult service evaluates patients who are admitted to the hospital with gastrointestinal (GI) tract bleeding. Prompt endoscopic evaluation is the mainstay for the diagnosis and treatment of clinically significant GI tract bleeding and occurs in concert with the initiation of supportive measures, including replacement of lost blood, correction of coagulopathy, treatment of hemorrhagic shock, and stimulation of erythropoiesis. There have been several case reports of patients who exsanguinated from acute GI tract bleeding due to refusal of blood or blood products on religious grounds. Management of such patients presents many treatment and ethical challenges. The Jehovah's Witnesses population literally interprets the Bible passages Genesis 9:4, "But flesh with the life thereof, which is the blood thereof, shall ye not eat. " and Leviticus 17: 15, "And every soul that eateth that which died of itself, or that which was torn with beasts, whether it be one of your own country, or a stranger, he shall both wash his clothes, and bathe himself in water, and be unclean until the even: then shall he be clean. " to mean that they should not ingest blood and thus they do not accept blood or blood products. Nonetheless, there are alternatives, albeit limited, to transfusion of human blood products for patients with acute blood loss secondary to GI tract bleeding. For example, research studies have demonstrated favorable outcome