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Anaemia Jehovahs Witness CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseAnaemia Jehovahs Witness CKDESENeph

A 48-year-old woman with CKD G3b develops symptomatic anaemia (Hb 85 g/L). She is a Jehovah's Witness and declines blood transfusion. She has iron deficiency (ferritin 30, TSAT 12%). What is the approach?

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Correct answer: B — IV iron replacement (Ferric Derisomaltose or FCM) is the priority to replete iron stores; ESA should be started concurrently given the urgency and transfusion refusal; close monitoring with more aggressive Hb targeting may be appropriate in this context

In Jehovah's Witness patients with CKD anaemia, avoiding transfusion makes aggressive iron and ESA management particularly important. IV iron (rather than oral, which is slower and less reliable) should be given urgently to replete stores. ESA should be started concurrently rather than sequentially to minimise time in severe anaemia. In this specific context, some clinicians may target a slightly higher Hb (e.g. 110-120 g/L) than standard to provide a safety margin, though this must be balanced against ESA cardiovascular risks. Advanced care planning regarding emergency transfusion refusal should be documented.

Reference: KDIGO 2025 – Anemia in CKD; Hospital Blood Management – Jehovah's Witness