In severely anaemic patients, blood transfusions remain the standard of care when haemoglobin levels become dangerously low. However, in some situations blood transfusion is not an option. In this clinical lesson, we present a case of a young Jehovah's Witness who developed a life-threatening anaemia due to a gastro-intestinal bleeding. The patient did not want to receive blood products. Although blood transfusions seemed crucial, we successfully treated our patient with only supportive measures. This articles gives an overview of supportive treatment options in severely anaemic patients in the absence of blood transfusions. These measures include monitoring and optimization of hemodynamics, prevention of further blood loss, correction of the haemostatic balance, enhancing haemostasis, improving oxygen delivery and optimizing haematopoiesis.