Blood transfusions are paramount in the management of hemorrhages related to surgery, trauma, or certain bleeding disorders. However, some patients may refuse blood products or carry certain conditions that potentially lead to harm if transfused (i.e. pregnant or immunocompromised patients). The most common group of people who refuse blood transfusions are from the Jehovah’s Witness (JW) faith. Fortunately, there are alternatives for blood transfusions, most being pharmacotherapy agents that have been studied in different settings and populations, some of which included JWs. The alternatives to blood transfusions include: iron replacement, erythropoietin stimulating agents (ESAs), tranexamic acid (TXA), recombinant factor VII products (rVIIa), and Hemoglobin-Based Oxygen Carriers (HBOCs). A combination of the previously listed options may be considered for some individuals. Utilization of these alternatives will ultimately depend on the patient’s approval along with the severity of the hemorrhage. It is important to note these alternatives are not widely studied in this population and some of the literatures are based on case reports or other smaller studies. This indicates the need for more robust studies to be conducted to make a more reliable recommendation for the treatment of hemorrhages in these patients.