The New England Journal of Medicine 2002; 346: 1097-1098 SACRAMENTO Jose Orduno lay dying. Doctors grumbled about their lack of options. And Orduno's sister, Angelica, wondered how she would tell their frail mother that he had refused lifesaving blood transfusions because of his faith. "You walk around with your arms tied behind your back," said Mercy San Juan Hospital trauma surgeon Leon Owens. "It's torture." But Orduno didn't die. After two weeks in the hospital, breathing through a tube in his throat, the 34-year-old was offered a long shot: an experimental therapy made from the blood of cattle. Before sunup July 21, Orduno was nearing the end of his 40-minute bike ride to McDonald's, where he worked making salads, when he was hit by a car. He remembers nothing of the accident, but learned later that he was thrown about 90 feet, and that the driver of the car that hit him fled. After Orduno had received two units of a donor's blood, he awoke to tell the doctors and nurses surrounding him that he didn't want any more. Although Orduno never officially has been baptized a Jehovah's Witness, he would explain later that he subscribes to the denomination's doctrine and is well-versed in its practices. But a company called Biopure has developed an alternative therapy for situations in which patients can't or won't accept blood transfusions. The hospital checked on whether Hemopure would be an acceptable alternative to whole blood, and it was cleared. After getting the drug intravenously over three or four days, Orduno's hemoglobin level shot up, reviving his body's ability to produce new oxygen-carrying red blood cells. Dorsey Griffith, a medical writer for the Sacramento Bee, states that Gregory Brown, a representative from the Jehovah's Witnesses Hospital Liaison Committee, approved the use of the oxygen-carrying solution that was transfused into the patient, Jose Orduo. The article notes: "When Orduo woke up from his drug-induced slumber, about a month after the ordeal began, Angelica was there. His sister told him about the accident and how he almost died, and about the drug made from cow blood that had saved his life." So if we call these products *blood substitutes*/*drugs*/*transfusion free medication*/*oxygen carrying solutions* - they are acceptable to Jehovah's Witnesses, regardless of the fact that they are produced from haemoglobin (in this case from cow blood) which constitutes just under 15% of blood? And shouldn't bovine blood be poured upon the ground? Wasn't this the understanding underlying the apostolic decree to *abstain from blood*? Erythopoientin for Jehovah's WitnessesBased on interpretations of biblical scriptures (Verses 28 and 29 in Acts), Jehovah's witnesses believe that humans must not sustain life with other creatures' blood, and they recognize no difference between ingesting blood and taking it into their blood vessels. 1,2 When serious blood loss occurs from trauma, surgery, gastrointestinal bleeding, etc, physicians may be faced with the difficult problem of treating patients who are Jehovah's Witnesses while honoring their religious beliefs. Giving blood or blood products to sustain life may save the patients life, but Jehovah's Witnesses believe that it may ultimately destroy their soul. P> The Drug Information and Pharmacy Resource Center has received several questions about using erythropoietin (EPO) in Jehovah's Witnesses. EPO is an endogenous hormones produced primarily by the kidneys that stimulates the bone marrow to produce red blood cells in response to hypoxemia. Using recombinant DNA technology, exogenous EPO is now commercially available and is routinely used to treat anemia in predialysis patients, patients with end-stage renal failure, and patients infected with HIV with anemia related to zidovudine therapy. In patients who are Jehovah's Witnesses, EPO has been proposed as an alternative to administering blood products to replace lost blood or to increase their vascular volume before elective surgery. 2-5 EPO has been useful in the Jehovah's Witnesses reported in the literature in whom it has been used instead of blood or blood products. P> There is an issue that has created some debate. In each vial of EPO contains a small amount (ie, 2.5 mg) of human albumin, a blood product, as a carrier protein to prevent adsorptive losses of EPO. 2,6 There is no form of EPO available in this country that does not contain this small amount of albumin. The controversy is whether this small amount of albumin makes the use of exogenous EPO unacceptable in Jehovah's Witnesses. P> There is no definitive answer to this question. Before treating a Jehovah's Witness with EPO, it must be considered whether it is acceptable to them. The patient or their family may wish to consult their religious leaders for guidance. The Watchtower Society's Bible Information Services has stated that the use of EPO should not objectionable in Jehovah's Witnesses who receive treatment with EPO because this synthetic hormone is a product of recent technology. There might, however, be some individual Jehovah's Witnesses who would find it unacceptable to use a solution that contains albumin. Each individual must decide if it is appropriate. REFERENCESol> LI>Thompson HA. Blood transfusions and Jehovah's Witnesses. Tex Med 1989;85:57-9. | 
