Transfusion Dilemma/Coagulation TEG

2019 ◽  
pp. 78-84
Author(s):  
Lorent Duce ◽  
Amanda Frantz
Keyword(s):  
Blood Loss ◽  
Old Testament ◽  
Treatment Options ◽  
Healthcare Team ◽  
Management Options ◽  
Unique Challenge ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
The Bible ◽  
Bloodless Surgery

The healthcare team is presented with a unique challenge when providing bloodless surgery to patients of the Jehovah’s Witness faith who refuse allogenic transfusions based on religious beliefs. The Jehovah’s Witness faith interprets New and Old Testament passages of the Bible, including Genesis 9:4, as God commanding against “eating blood,” thus preventing believers from receiving transfusions of blood products. When it comes to complex cardiac surgery, where blood loss and coagulopathy are common, the physician and patient must establish a plan for blood conservation and optimization of hemoglobin preoperatively. Knowledge of management options during the preoperative period as well as treatment options for blood loss is imperative to honor patient autonomy and avoid ethical dilemmas.

Bloodless Surgery in a Jehovah’s Witness Patient with a 12.7-kg Uterine Leiomyosarcoma

2007 ◽  
Vol 64 (4) ◽  
pp. 212-219 ◽  
Author(s):  
Nimesh P. Nagarsheth ◽  
Aryeh Shander ◽  
Robert Malovany ◽  
Jausheng Tzeng ◽  
Ibrahim Ibrahim
Keyword(s):  
Uterine Leiomyosarcoma ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Bloodless Surgery ◽  
Witness Patient

Chemotherapy, Erythropoietin and Bloodless Surgery in a Jehovah's Witness

2003 ◽  
Vol 15 (7) ◽  
pp. 371-377 ◽  
Author(s):  
J.E. Brown ◽  
M.Q. Hatton ◽  
R. Melchers ◽  
P. Goldstraw ◽  
R.E. Coleman
Keyword(s):  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Bloodless Surgery

Erythropoietin and Desmopressin Obviated Transfusion in a Thromboasthenic Jehovah's Witness Undergoing Scoliosis Surgery

1996 ◽  
Vol 2 (1) ◽  
pp. 11-13
Author(s):  
Stefan Lethagen ◽  
Magnus K. Karlsson
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Bleeding Time ◽  
Hemoglobin Concentration ◽  
Scoliosis Surgery ◽  
Scoliosis Patient ◽  
Platelet Dysfunction ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Erythropoietin Treatment

A 13-year-old female Jehovah's Witness with thromboasthenia was scheduled for scoliosis surgery. To reduce the risk of heterologous transfusion, she was given erythropoietin for 2 weeks preoperatively. Bleeding time and platelet dysfunction normalized during erythropoietin treatment, but the hemoglobin concentration increased only marginally. Desmopressin and tranexamic acid were given as cover for surgery. Blood loss was less than that in the average scoliosis patient, 1,490 ml as compared to 2,740 ml, and no heterologous transfusion was given. Erythropoietin may thus be given preoperatively, not only to increase the hemoglobin concentration, but also to improve the platelet function in thromboasthenic pa tients.

scholarly journals Life-threatening postoperative blood loss in a Jehovah's Witness, treated with high-dose erythropoietin

2005 ◽  
Vol 94 (4) ◽  
pp. 442-444 ◽  
Author(s):  
G. Scha¨lte ◽  
H. Janz ◽  
J. Busse ◽  
V. Jovanovic ◽  
R. Rossaint ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postoperative Blood Loss ◽  
High Dose ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Life Threatening

scholarly journals BLOODLESS SURGERY AND MEDICINE FOR JEHOVAH'S WITNESS-ROLE OF INFORMED CONSENT AND MEDICAL COOPERATION-

2008 ◽  
Vol 54 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Shunji Kawamoto ◽  
Kazuo Inada ◽  
Takayuki Kanemaru ◽  
Shuji Nagao ◽  
Ryoji Ochiai ◽  
...  
Keyword(s):  
Informed Consent ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Bloodless Surgery

scholarly journals Successful Management of Thrombotic Thrombocytopenic Purpura in a Jehovah’s Witness: An Individualized Approach With Joint Decision-Making

2019 ◽  
Vol 7 (1) ◽  
pp. 8-11
Author(s):  
Ming Y Lim ◽  
Charles S Greenberg
Keyword(s):  
Decision Making ◽  
Replacement Therapy ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Blood Products ◽  
Thrombocytopenic Purpura ◽  
Joint Decision ◽  
Unique Challenge ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Individualized Approach

The management of thrombotic thrombocytopenic purpura (TTP) presents a unique challenge in individuals who are unable to accept plasma due to religious beliefs, given that therapeutic plasma exchange (TPE) is the standard of care. A 61-year-old Jehovah’s Witness woman presented to our hospital with neurological symptoms and laboratory findings suggestive of TTP. On admission, she refused transfusion of blood products, specifically red blood cells, platelets, and plasma but accepted albumin and intravenous immunoglobulin (IVIG); fractions of plasma. She was started on steroids, IVIG, and TPE with albumin as replacement therapy with minimal improvement. After a detailed discussion with the patient and family, they agreed to accept cryosupernatant. The patient started TPE with cryosupernatant for replacement therapy, which resulted in clinical improvement. This case highlights the importance of an individualized approach with joint decision-making given the significant heterogeneity that exists in Jehovah’s Witnesses’ attitude toward the receipt of blood products.

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