Managing Blood Loss in a Jehovah’s Witness Patient

2018 ◽  
Author(s):  
Michelle Dalton
Keyword(s):  
Blood Loss ◽  
Religious Belief ◽  
Perioperative Care ◽  
Red Cells ◽  
Blood Products ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Witness Patient

The Jehovah’s Witnesses are a unique group of patients that can pose a challenge to the anesthesiologist given their desire to avoid transfusion of blood products. This religious belief can include refusal of red cells, white cells, plasma, as well as platelets. The perioperative care of such patients can include the use of bloodless techniques in order to respect their beliefs. Given the desire to avoid blood products, it is imperative to utilize strategies that will prevent unnecessary transfusion. It is also important to understand the ethical and or legal ramifications of overriding parental/adolescent requests for no transfusion as well as acceptance of adolescent transfusion refusal.

Use of Erythropoietin in the Severely Anemic Jehovah's Witness Patient: Case Report and Review of the Literature

1997 ◽  
Vol 13 (6) ◽  
pp. 252-257
Author(s):  
P David Rogers ◽  
David F Volles
Keyword(s):  
Religious Beliefs ◽  
Motor Vehicle ◽  
Alternative Methods ◽  
Severe Anemia ◽  
Blood Products ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Witness Patient

Objective: To describe and discuss the use of erythropoietin as a therapeutic option for treatment of severe anemia in a patient whose religious beliefs preclude the use of blood products. Case Summary: A 23-year-old male Jehovah's Witness patient presented to the emergency department with multiple fractures and significant blood loss secondary to trauma experienced in a motor vehicle accident. The patient refused transfusion because of his religious beliefs. He was given oxygen and lactated Ringer's solution, and phlebotomy was kept to a minimum. Erythropoietin was recommended to increase production of red blood cells. Review of the product information revealed that all available erythropoietin products contain human albumin as a stabilizer. After discussion with the clinical pharmacist, the patient and his family agreed to the use of erythropoietin. The patient's hematocrit and hemoglobin improved sufficiently for him to be taken to surgery on hospital day 12, and on hospital day 23 he was discharged. Discussion: Because Jehovah's Witnesses refuse to receive blood products, alternative methods for treatment of severe anemia must be used. Although some options are clearly unacceptable, certain volume expanders can be used in conjunction with oxygen and intravenous or oral iron that do not violate the patient's religious convictions. Erythropoietin is acceptable to most Jehovah's Witnesses; however, it contains human album (2.5 mg/mL), which may be of concern to some of these patients. Conclusions: Effective communication with the patient and the patient's family regarding all treatment options is required for treatment of severe anemia in the Jehovah's Witness patient. Erythropoietin, in conjunction with iron, adequate oxygenation, and good nutritional support, sometimes is an acceptable alternative in Jehovah's Witnesses.

scholarly journals Major abdominal surgery in Jehovah’s Witnesses

2016 ◽  
Vol 98 (8) ◽  
pp. 532-537 ◽  
Author(s):  
KE Rollins ◽  
U Contractor ◽  
R Inumerable ◽  
DN Lobo
Keyword(s):  
Abdominal Surgery ◽  
Moral Dilemmas ◽  
Major Abdominal Surgery ◽  
Major Surgery ◽  
Blood Products ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Jehovah’S Witness ◽  
Liaison Committee ◽  
Jehovah's Witness

Introduction Patients who are Jehovah’s Witnesses pose difficult ethical and moral dilemmas for surgeons because of their refusal to receive blood and blood products. This article outlines the personal experiences of six Jehovah’s Witnesses who underwent major abdominal surgery at a single institution and also summarises the literature on the perioperative care of these patients. Methods The patients recorded their thoughts and the dilemmas they faced during their surgical journey. We also reviewed the recent literature on the ethical principles involved in treating such patients and strategies recommended to make surgery safer. Results All patients were supported in their decision making by the clinical team and the Hospital Liaison Committee for Jehovah’s Witnesses. The patients recognised the ethical and moral difficulties experienced by clinicians in this setting. However, they described taking strength from their belief in Jehovah. A multitude of techniques are available to minimise the risk associated with major surgery in Jehovah’s Witness patients, many of which have been adopted to minimise unnecessary use of blood products in general. Nevertheless, the risks of catastrophic haemorrhage and consequent mortality remain an unresolved issue for the treating team. Conclusions Respect for a patient’s autonomy in this setting is the overriding ethical principle, with detailed discussion forming an important part of the preparation of a Jehovah’s Witness for major abdominal surgery. Clinicians must be diligent in the documentation of the patient’s wishes to ensure all members of the team can abide by these.

Redo cardiac surgery in a Jehovah’s Witness, the importance of a multidisciplinary approach to blood conservation

Perfusion ◽  
2000 ◽  
Vol 15 (3) ◽  
pp. 251-255 ◽  
Author(s):  
S Jovanovic ◽  
S D Hansbro ◽  
C M Munsch ◽  
M H Cross
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Multidisciplinary Approach ◽  
Artery Bypass ◽  
Blood Conservation ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Jehovah’S Witness ◽  
Jehovah's Witness

Although Jehovah’s Witnesses present a particular problem when undergoing surgery because of their refusal to accept stored blood, it is now quite common to undertake uncomplicated cardiac surgery in these patients. Complex or redo cardiac surgery however, is often associated with major blood loss, and is conventionally contraindicated in Jehovah’s Witnesses. We describe the perioperative management of a Jehovah’s Witness who underwent a resternotomy for mitral valve replacement and coronary artery bypass grafting having previously had an aortic valve replacement and mitral valve repair. The importance of a multidisciplinary approach to blood conservation is discussed.

scholarly journals Major liver surgery in a Jehovah’s Witness patient: challenges for safe surgery

2019 ◽  
pp. 24-26
Author(s):  
WY Lim ◽  
L Loh ◽  
SR Desai ◽  
SL Tien ◽  
BK Goh ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Major Surgery ◽  
Blood Products ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Safe Surgery ◽  
Patient Consent ◽  
Witness Patient

Jehovah’s Witnesses presenting for major surgery run the risk of major bleeding, which is complicated by the refusal to accept blood transfusion. We present a case of a 63-year-old woman, a Jehovah’s Witness, who was diagnosed with hepatocellular carcinoma and advised for curative laparoscopic liver segmentectomy. Due to the risk of significant intraoperative haemorrhage, her perioperative care was coordinated in a multidisciplinary manner. Informed consent requires the physician to advise on the material risks of undertaking major surgery without blood transfusion and the possible alternatives. Conflicting ethical issues of patient autonomy and beneficence related to refusal of blood products also arise. Perioperative strategies to minimise blood loss, maximise haematopoiesis and tolerance of anaemia to facilitate safe surgery in such patients are also presented. Written patient consent obtained.

scholarly journals Management of thrombotic thrombocytopenic purpura without plasma exchange: the Jehovah’s Witness experience

2017 ◽  
Vol 1 (24) ◽  
pp. 2161-2165 ◽  
Author(s):  
James N. George ◽  
Steven A. Sandler ◽  
Joanna Stankiewicz
Keyword(s):  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Jehovah’S Witnesses ◽  
Thrombocytopenic Purpura ◽  
Jehovah's Witnesses ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Key Points ◽  
The Future

Key Points TTP in Jehovah’s Witness patients has been managed successfully without PEX. This experience, plus new TTP treatments, may make it possible for patients who are not Jehovah’s Witnesses to avoid PEX in the future.

Severe anemia in the Jehovah's Witness: case report and discussion

1993 ◽  
Vol 2 (3) ◽  
pp. 256-259 ◽  
Author(s):  
SL Collins ◽  
GA Timberlake
Keyword(s):  
Case Report ◽  
Blood Loss ◽  
Severe Anemia ◽  
Blood Products ◽  
Jehovah’S Witness ◽  
Airplane Crash ◽  
Jehovah's Witness ◽  
Life Threatening

Major blood loss following trauma is common, but severe anemia is generally not life-threatening when managed with the administration of blood and blood products. Severe anemia becomes particularly challenging and potentially lethal when the patient is a Jehovah's Witness, for whom receiving a transfusion is contrary to religious principles. This case report describes the management and hospital course of a Jehovah's Witness who was seriously injured in an airplane crash.

Cardiopulmonary bypass on a Jehovah's Witness child

Perfusion ◽  
1986 ◽  
Vol 1 (4) ◽  
pp. 293-295
Author(s):  
PA Grey ◽  
JR Crockett
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Full Recovery ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Membrane Lung

A four-year-old boy was admitted for closure of a congenital ventricular septal defect. As the boy's parents were Jehovah's Witnesses, transfusion of blood was proscribed. Cardiopulmonary bypass was achieved using a Variable Prime Cobe Membrane Lung (VPCML). Extreme haemodilution was experienced, during bypass the haematocrit fell to a level of 8%. The haematocrit rose over the next two days to 22% and the patient made a full recovery.

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