# A dream or reality: Consideration of ‘bloodless’ hematopoietic stem cell transplants for Jehovah’s witness patients

## TL;DR

This paper explores the feasibility of performing bloodless stem cell transplants for patients, like Jehovah’s Witnesses, who cannot receive blood transfusions.

## Contribution

The paper presents a successful implementation of a bloodless HSCT protocol for Jehovah’s Witness patients at a Canadian center.

## Key findings

- Three Jehovah’s Witness patients underwent bloodless transplants with no significant bleeding or hemoglobin below 8.0 g/dL.
- All patients recovered without blood transfusions and had hospital stays similar to standard transplants.
- Tailored protocols enabled safe HSCT for patients previously considered unsuitable due to blood transfusion restrictions.

## Abstract

Hematopoietic stem cell transplantation (HSCT) is an important part of treatment for many hematologic conditions. The high-dose chemotherapy used in HSCTs puts patients at risk of significant cytopenias which often necessitate blood product transfusions. Certain populations, including Jehovah’s Witnesses, are unable to receive blood product transfusions during their transplant and thus, in the past, they have been seen as unsuitable candidates for transplantations. However, there has been growing evidence of the safety and efficacy of so-called “bloodless” HSCT protocols.

The most recent and relevant literature on “bloodless” transplants were identified through Embase, MEDLINE, and PubMed, and analyzed to construct a “bloodless” HSCT protocol at a Canadian centre. Since 2021, the regimen was utilized for four autologous transplantations in three different Jehovah’s Witness patients.

None of the patients had a significant bleeding event nor a hemoglobin nadir below 8.0 g/dL. Minor bleeding events, predominantly mucositis, resolved with site-specific management. No patient had significant thrombocytopenia, and all the cell lines of patients had normalized without transfusions by the time of discharge. All patients were hospitalized for <30 days, similar to the experience of the centre with “regular” autologous transplants.

Careful planning and tailored regimens support the achievability of “bloodless” HSCTs in patients, such as Jehovah’s Witnesses, allowing practitioners to provide care to a previously excluded group and minimize the use of blood products in all HSCT patients.