# Use of Epoetin Alfa for Anemia of Chronic Disease in a Jehovah’s Witness Teenager With Disseminated Coccidioidomycosis: A Case Report

## TL;DR

A 19-year-old Jehovah’s Witness with a severe fungal infection and anemia avoided blood transfusion by using epoetin alfa to manage his condition before surgery.

## Contribution

This case report presents a rare use of epoetin alfa for infection-related anemia in a pediatric patient refusing blood transfusion.

## Key findings

- Epoetin alfa was used successfully as a transfusion-sparing strategy in a Jehovah’s Witness with severe anemia.
- The treatment was administered prior to surgery for a disseminated fungal infection.
- The case suggests epoetin alfa may be a viable option for managing infection-related anemia in select patients.

## Abstract

Anemia of chronic disease is a common complication of prolonged infection and systemic inflammation and can be difficult to manage in patients who decline blood transfusion, such as Jehovah’s Witnesses. Erythropoiesis-stimulating agents are widely used in renal and oncologic settings but are rarely reported in infection-associated anemia among pediatric or young adult patients. We describe a 19-year-old Jehovah’s Witness male with disseminated Coccidioides immitis infection complicated by severe anemia of chronic disease. Because blood transfusion was declined, epoetin alfa was administered as a transfusion-sparing strategy prior to surgical intervention. This case highlights a potential role of epoetin alfa as an alternative strategy for managing infection-related anemia in select patients when transfusion is not an option.