{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T12:06:41Z","timestamp":1779797201565,"version":"3.53.1"},"reference-count":13,"publisher":"SAABRON PRESS","issue":"2","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>A practicing Jehovah\u2019s Witness with diagnosed IgM monoclonal gammopathy of undetermined significance (MGUS) in 2014 was hospitalized within one year of her annual checkup. She had hyperviscosity syndrome with blurry vision and severe anemia but, due to religious beliefs, would not accept blood products. She was treated with therapeutic plasma exchange therapy with subjective improvement of her blurry vision, decrease in her serum viscosity, and improvement of her anemia. This bloodless medicine patient (BMP) had annual follow up per the Mayo Clinic Stratification System guidelines for her asymptomatic MGUS, as she fell into the intermediate-risk category given her age, laboratory values, and lack of symptoms. Due to the inability to provide proper rescue therapy with blood products in the event of anemia, we suggest adjusting the monitoring and surveillance interval for BMPs regardless of laboratory values. We suggest that BMPs undergo additional monitoring including iron and coagulation studies to preempt and prevent potential complications of symptomatic anemia, coagulopathy, and hyperviscosity syndrome. We recommend shortening the follow-up for these patients to every 3-6 months, as opposed to the standard follow-up that is recommended for IgM MGUS (typically ranging from 6-12 months). This would also drive earlier conversations about the risks and benefits of initiating earlier treatment in these patients, given their risks of complications if their MGUS progresses to malignancy.<\/jats:p>","DOI":"10.46989\/001c.158440","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T13:22:44Z","timestamp":1776950564000},"source":"Crossref","is-referenced-by-count":0,"title":["Should monitoring guidelines and decision to treat for I\u2060gM MGUS be different when caring for Jehovah\u2019s Witness patients?"],"prefix":"10.46989","volume":"8","author":[{"given":"Marshall","family":"Rosenberg","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Lankenau Medical Center 100 E Lancaster Ave, Penn Wynne, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisha P.","family":"Maity","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Lankenau Medical Center 100 E Lancaster Ave, Penn Wynne, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Shankar","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Lankenau Medical Center 100 E Lancaster Ave, Penn Wynne, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Dunne","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Lankenau Medical Center 100 E Lancaster Ave, Penn Wynne, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arezoo","family":"Ghaneie","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Lankenau Medical Center 100 E Lancaster Ave, Penn Wynne, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"26435","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"issue":"2","key":"ref1","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1002\/ajh.26796","article-title":"Waldenstr\u00f6m macroglobulinemia: 2023 update on diagnosis, risk stratification, and management","volume":"98","author":"M. A. Gertz","year":"2023","journal-title":"American Journal of Hematology"},{"issue":"18","key":"ref2","doi-asserted-by":"publisher","first-page":"3635","DOI":"10.1182\/blood-2010-03-274571","article-title":"In anemia of multiple myeloma, hepcidin is induced by increased bone morphogenetic protein 2","volume":"116","author":"K. Maes","year":"2010","journal-title":"Blood"},{"issue":"18","key":"ref3","doi-asserted-by":"publisher","first-page":"4163","DOI":"10.1182\/blood-2008-08-174961","article-title":"International prognostic scoring system for Waldenstrom macroglobulinemia","volume":"113","author":"P. Morel","year":"2009","journal-title":"Blood"},{"issue":"2","key":"ref4","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1182\/blood-2017-09-807560","article-title":"How I manage monoclonal gammopathy of undetermined significance","volume":"131","author":"Ronald S. Go","year":"2018","journal-title":"Blood"},{"issue":"3","key":"ref5","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1056\/NEJMoa1709974","article-title":"Long-term follow-up of monoclonal gammopathy of undetermined significance","volume":"378","author":"R. A. Kyle","year":"2018","journal-title":"New England Journal of Medicine"},{"issue":"3","key":"ref6","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1046\/j.1365-2141.2001.03144.x","article-title":"Waldenstr\u00f6m macroglobulinaemia: Presenting features and outcome in a series with 217 cases","volume":"115","author":"R. Garc\u00eda-Sanz","year":"2001","journal-title":"British Journal of Haematology"},{"issue":"3","key":"ref7","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1002\/jca.21276","article-title":"Guidelines on the use of therapeutic apheresis in clinical practice\u2014evidence-based approach from the Writing Committee of the American Society for Apheresis: The sixth special issue","volume":"28","author":"J. Schwartz","year":"2013","journal-title":"Journal of Clinical Apheresis"},{"key":"ref8","series-title":"StatPearls [Internet]","article-title":"Lymphoplasmacytic lymphoma","author":"H. Kaseb","year":"2023"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1002\/ajh.25254","article-title":"Predictors of symptomatic hyperviscosity in Waldenstr\u00f6m macroglobulinemia","volume":"93","author":"J. P. Abeykoon","year":"2018","journal-title":"American Journal of Hematology"},{"issue":"3","key":"ref10","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1213\/ANE.0000000000006114","article-title":"Methods of bloodless care, clinical outcomes, and costs for adult patients who decline allogeneic transfusions","volume":"135","author":"S. M. Frank","year":"2022","journal-title":"Anesthesia & Analgesia"},{"issue":"12","key":"ref11","first-page":"826","article-title":"Transfusion replacement strategies in Jehovah's Witnesses and others who decline blood products","volume":"18","author":"T. G. DeLoughery","year":"2020","journal-title":"Clinical Advances in Hematology & Oncology"},{"issue":"1","key":"ref12","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3816\/CLM.2009.n.002","article-title":"IgM monoclonal gammopathy of undetermined significance and smoldering Waldenstr\u00f6m's macroglobulinemia","volume":"9","author":"R. A. Kyle","year":"2009","journal-title":"Clinical Lymphoma Myeloma"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"34","DOI":"10.12703\/r\/11-34","article-title":"Monoclonal gammopathy of undetermined significance: evaluation, risk assessment, management, and beyond","volume":"11","author":"J. P. Abeykoon","year":"2022","journal-title":"Faculty reviews"}],"container-title":["Clinical Hematology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/chi.scholasticahq.com\/article\/158440-should-monitoring-guidelines-and-decision-to-treat-for-i-gm-mgus-be-different-when-caring-for-jehovah-s-witness-patients","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:26:42Z","timestamp":1779794802000},"score":1,"resource":{"primary":{"URL":"https:\/\/chi.scholasticahq.com\/article\/158440-should-monitoring-guidelines-and-decision-to-treat-for-i-gm-mgus-be-different-when-caring-for-jehovah-s-witness-patients"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":13,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.46989\/001c.158440","relation":{},"ISSN":["2590-0048"],"issn-type":[{"value":"2590-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]}}}