[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-461683-105":59,"doc-detail-461683-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","management-challenges-of-life-threatening-thrombosis-and-hemorrhage-in-a-jehovahs-witness-patient-with-hereditary-hemorrhagic-telangiectasia-a-case-report","Management Challenges of Life-Threatening Thrombosis and Hemorrhage in a Jehovah’s Witness Patient With Hereditary Hemorrhagic Telangiectasia - A Case Report","","Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disorder with mucocutaneous telangiectasias and arteriovenous malformations across multiple organs. Manifestations often include recurrent epistaxis and chronic iron deficiency anemia, with potential gastrointestinal bleeding, high-output cardiac failure, stroke, and venous thromboembolism. This case report describes an 84-year-old Jehovah’s Witness with HHT, heart failure, and atrial fibrillation admitted for worsening exertional dyspnea, where imaging confirmed massive pulmonary embolism with right heart strain. Anticoagulation was limited by recurrent epistaxis, new GI bleeding, and refusal of blood transfusion, leading to discontinuation, decline, and death despite supportive and palliative care.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/management-challenges-of-life-threatening-thrombosis-and-hemorrhage-in-a-jehovahs-witness-patient-with-hereditary-hemorrhagic-telangiectasia-a-case-report/461683/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/management-challenges-of-life-threatening-thrombosis-and-hemorrhage-in-a-jehovahs-witness-patient-with-hereditary-hemorrhagic-telangiectasia-a-case-report/461683.png","ImageObject",300,407,{"name":92,"@type":93},"ahduag","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is hereditary hemorrhagic telangiectasia (HHT) and what complications can it cause?","Question",{"text":113,"@type":114},"HHT is a rare autosomal dominant vascular disorder marked by mucocutaneous telangiectasias and arteriovenous malformations in multiple organs. It commonly presents with recurrent epistaxis and iron deficiency anemia, and it can lead to gastrointestinal bleeding, high-output cardiac failure, stroke, and venous thromboembolism.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did the case describe managing massive pulmonary embolism in the presence of HHT-related bleeding risk?",{"text":118,"@type":114},"After imaging confirmed massive pulmonary embolism with right heart strain, split-dose low molecular weight heparin was initiated. Management was constrained by recurrent epistaxis, new-onset GI bleeding, and refusal of blood transfusion, so anticoagulation was discontinued to reduce further bleeding risk.",{"name":120,"@type":111,"acceptedAnswer":121},"Why was anticoagulation eventually discontinued and what was the outcome?",{"text":122,"@type":114},"Anticoagulation was stopped due to ongoing bleeding concerns, including progression to melena and continued clinical deterioration. Blood transfusion was discussed but declined per the patient’s advance directive, and supportive and palliative measures were initiated before the patient passed away following decline.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},461683,1790789688,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},3985747870414,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Review began 11/17/2025  \nReview ended 12/06/2025  \nPublished 12/10/2025  \n© Copyright 2025  \nNaeem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98904  \nOpen Access Case Report  \nManagement Challenges of Life-Threatening Thrombosis and Hemorrhage in a Jehovah’s Witness Patient With Hereditary Hemorrhagic Telangiectasia: A Case Report  \nAhmed Naeem 1, Sughra M. Mangrio 1 , Aaiza Azhar 2, 3 , Usmaan Khan 1  \n1. General Internal Medicine, Russells Hall Hospital, Dudley, GBR 2. Internal Medicine, Independent Research, Dudley, GBR 3. Internal Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK  \nCorresponding author: Ahmed Naeem, [ahmed.naeem2@nhs.net](ahmed.naeem2@nhs.net)  \nAbstract  \nHereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disorder characterized by mucocutaneous telangiectasias and arteriovenous malformations (AVMs) affecting multiple organ systems. Clinical manifestations commonly include recurrent epistaxis and chronic iron deficiency anemia, while complications such as gastrointestinal (GI) bleeding, high-output cardiac failure, stroke, and venous thromboembolism may occur. Management can be further complicated when an anticoagulant is indicated. We present a case of an 84-year-old female Jehovah’s Witness with known HHT, heart failure, and atrial fibrillation who was admitted with worsening exertional dyspnea. Baseline investigations revealed type 1 respiratory failure and elevated D-dimer, and imaging confirmed the diagnosis of massive pulmonary embolism with right heart strain. In light of this diagnosis, she was started on split-dose low molecular weight heparin (LMWH) ; however, management was significantly constrained by her history of recurrent epistaxis and new-onset GI bleeding, as well as refusal of blood transfusion in accordance with her religious beliefs. Despite standard interventions by ENT to control her nasal bleeding, including cauterization and topical medications, she developed melena and continued to regress afterwards. Anticoagulation was hence discontinued at that time to minimize any further risk of bleeding, but her condition continued to deteriorate. Blood transfusion was discussed but was declined, consistent with the patient’s advance directive. Supportive and palliative measures were initiated, but the patient subsequently passed away following clinical decline. This case highlights the complex clinical and ethical challenges of balancing thrombosis and hemorrhage in patients with HHT, particularly when standard interventions are not an option. It highlights the importance of individualized risk-benefit assessment, multidisciplinary involvement, and early engagement with hospital liaison services in Jehovah’s Witness patients to make sure that treatment aligns with patients ' personal beliefs, and this can prevent any delays in considering life-saving treatment, making sure that patients are well informed of the possibility of any adverse outcome beforehand. Additionally, it reflects the need for continued research into safe and effective alternatives to transfusion of blood products in patients where current standard treatment options, although effective, do not have the same clinical impact.  \nCategories: Hematology, Cardiology, Internal Medicine  \nKeywords: complex anticoagulation management, hereditary hemorrhagic telangiectasia (hht), inherited bleeding diathesis, jehovah 's witness, pulmonary embolism  \nIntroduction  \nHereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant genetic disorder, which means that, if a parent has HHT, there is a 50% chance that each child might inherit the condition, regardless of the gender of the parent or the c","cbCaig1S8KHMph9u","https://ap.wps.com/l/cbCaig1S8KHMph9u","pdf",1367076,"English","# Abstract\n# Introduction\n## Hereditary hemorrhagic telangiectasia overview\n## Clinical manifestations and complications\n## Pathogenesis and vascular features","[{\"question\":\"What is hereditary hemorrhagic telangiectasia (HHT) and what complications can it cause?\",\"answer\":\"HHT is a rare autosomal dominant vascular disorder marked by mucocutaneous telangiectasias and arteriovenous malformations in multiple organs. It commonly presents with recurrent epistaxis and iron deficiency anemia, and it can lead to gastrointestinal bleeding, high-output cardiac failure, stroke, and venous thromboembolism.\"},{\"question\":\"How did the case describe managing massive pulmonary embolism in the presence of HHT-related bleeding risk?\",\"answer\":\"After imaging confirmed massive pulmonary embolism with right heart strain, split-dose low molecular weight heparin was initiated. Management was constrained by recurrent epistaxis, new-onset GI bleeding, and refusal of blood transfusion, so anticoagulation was discontinued to reduce further bleeding risk.\"},{\"question\":\"Why was anticoagulation eventually discontinued and what was the outcome?\",\"answer\":\"Anticoagulation was stopped due to ongoing bleeding concerns, including progression to melena and continued clinical deterioration. Blood transfusion was discussed but declined per the patient’s advance directive, and supportive and palliative measures were initiated before the patient passed away following decline.\"}]","Management Challenges of Life-Threatening Thrombosis and Hemorrhage in a Jehovah’s Witness Patient With Hereditary Hemorrhagic Telangiectasia - A Case Report | PDF",1790762152,18]