(Sheesh, I always feel bad after being critical of others' writings)
I will offer a couple counterpoints to what I critiqued in my previous post.
The authors of the article in the OP say this about low HB levels:
Although the minimum hemoglobin level required to sustain life is unclear, a study of Jehovah’s Witnesses who declined blood products after surgery showed that some patients were able to survive with the lowest hemoglobin of 2.1–3.0 grams per deciliter, which is approximately 15-25% of normal. This suggests that even in the setting of profound blood loss, transfusions are not the only option for survival.
Note that no citation was offered for the profound "suggestion" that they offered. None. No citation. Just a "suggestion" based on a study that they didn't cite.
Then there is this which comes from an interview with Kaaron Benson, a doctor who has treated JWs with cancer:
Other groups of researchers have looked at larger patient populations. One study, which was reported in 2002 in Transfusion, looked at more than 2000 surgical patients with postoperative hemoglobin levels of 8 g/dL or lower who had declined red blood cell transfusions for religious reasons. This study found that as the hemoglobin level fell to 7 g/dL or lower, the adjusted risk increased 2.5-fold for every 1 g/dL decrease. When the hemoglobin level fell to 3 g/dL or lower, the in-hospital mortality at 1 month was 64%. This study did not find any immediate adverse effects as long as the patients’ hemoglobin level was greater than 7 g/dL.
and then, at the end of the article, we find the citation for the above quote:
Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion. 2002;42(7):812-818.
Now, let's take a quick look at what the authors of the OP article have to say about JWs with cancer:
Although not associated with overt blood loss, patients with cancer can also benefit significantly from bloodless medicine. Modern-day chemotherapy can have impressive cure rates in some cancers if treated aggressively. However, this often results in chemotherapy-related side effects as well as severe anemia and low platelets, from which patients may require significant transfusions in order to survive their treatment.
This poses a challenge in those who can potentially be cured but decline blood products, because modifications to chemotherapy (such as dose reduction), while more tolerable, may compromise the ability to attain cure; the management of these patients is extremely complex and should be considered on a case-by-case basis. In patients for whom the goal of treatment is not curative (ie, a “palliative” strategy), we recommend adjusting the chemotherapy in such a way so as to not require transfusions. Notably, small studies and case reports of Jehovah’s Witness cancer patients have reported favorable response to treatment when supplemented with aggressive supportive measures and shear tolerance of significant anemia.
Then, let's read what a cancer specialist, Dr. Kaaron Benson, has to say about cancer treatment for JWs:
These patients are at increased risk for morbidity and mortality caused by severe anemia and thrombocytopenia. Years ago, our hospital did a retrospective study of the 58 Jehovah’s Witness oncology patients we had seen at our hospital from October 1986 through February 1994. Of the 15 patients who had transfusion requirements, 9 refused blood. One older woman had a postoperative stroke and a young woman died, likely because of the combination of severe anemia and thrombocytopenia. Long-term prognosis also may have been affected. We did find that younger patients were more likely than older ones to accept transfusion, and parents were more likely to accept transfusion for their children than for themselves.
We found that 10 of the 58 patients we evaluated had their treatment limited because of their refusal of blood. For example, surgery was restricted or not performed, chemotherapy was withheld or the dose was lowered, or radiation therapy was withheld because the physician did not want to create a situation in which the patient would need a blood transfusion.
