The delivery of a 25-year-old Jehovah's Witness was complicated by postpartum haemorrhage with a nadir haematocrit of 3%. To improve oxygen delivery without blood transfusion, FiO2 was increased to maximize dissolved oxygen delivery. Central venous oxygen saturation was used to assess tissue oxygenation. When blood products are refused, successful management of severe anaemia is possible with supportive medical care to achieve haemostasis, optimize oxygen delivery and promote haematopoiesis.
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