Abstract
Management of the profoundly anaemic patient who competently refuses blood transfusion will always prove challenging. This article provides a review of treatment strategies based around a recent case of a patient presenting after major gastrointestinal haemorrhage. The main part of management involves providing supportive intensive care, paying particular attention to oxygen delivery and consumption, and minimising further blood loss. Specific treatments, such as pharmacotherapy to promote erythropoiesis, are based largely on indirect evidence or expert opinion. Virtually all aspects of care involve carefully balancing a shifting profile of risks and benefits; a team approach and close communication with the family are essential. This patient's successful outcome has extended our understanding of this area, which is discussed. © The Intensive Care Society 2014.