scholarly journals Outcomes of cardiac surgery in Jehovah’s Witness patients: A review

Perfusion ◽  
2020 ◽  
pp. 026765912098037
Author(s):  
Aimee-Louise Chambault ◽  
Louise J Brown ◽  
Sophie Mellor ◽  
Amer Harky
Keyword(s):  
Cardiac Surgery ◽  
Case Reports ◽  
Case Series ◽  
Long Term Outcomes ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Literature Evidence

Objective: To review current literature evidence on outcomes of cardiac surgery in Jehovah’s Witness patients. Methods: A comprehensive electronic literature search was done from 2010 to 20th August 2020 identifying articles that discussed optimisation/outcomes of cardiac surgery in Jehovah’s Witness either as a solo cohort or as comparative to non-Jehovah’s Witnesses. No limit was placed on place of publication and the evidence has been summarised in a narrative manner within the manuscript. Results: The outcomes of cardiac surgery in Jehovah’s Witness patients has been described, and also compared, to non-Witness patients within a number of case reports, case series and comparative cohort studies. Many of these studies note no significant differences between outcomes of the two groups for a number of variables, including mortality. Pre-, intra and post-operative optimisation of the patients by a multidisciplinary team is important to achieve good outcomes. Conclusion: The use of a bloodless protocol for Jehovah’s Witnesses does not appear to significantly impact upon clinical outcomes when compared to non-Witness patients, and it has even been suggested that a bloodless approach could provide advantages to all patients undergoing cardiac surgery. Larger cohorts and research across multiple centres into the long term outcomes of these patients is required.

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 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.

scholarly journals Current surgical approach in cleft palate treatment

2015 ◽  
Vol 10 (3) ◽  
pp. 234-239
Author(s):  
Sorin TALĂ ◽  
◽  
Dan Mircea ENESCU ◽  
Mircea ANDRIESCU ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Cleft Palate ◽  
Retrospective Studies ◽  
Case Reports ◽  
Case Series ◽  
Long Term Outcomes ◽  
Exclusion Criteria ◽  
Pubmed Database ◽  
Made In

Objective. To evaluate the present state of cleft palate surgical treatment based on clinical studies after an extensive research of medical literature. Methods. The research was made in PubMed database between 2007-2014 taking in consideration surgical treatment of cleft palate and eliminating case reports, case series and reviews. Results. There was 1,677 articles with relevance for cleft palate surgical treatment and after applying exclusion criteria were retained 43 – 29 retrospective studies and 14 prospective. Conclusion. There isn’t a protocol treatment recognized by all the cleft palate centers, existing a variety of ways to manage this malformation. There are few studies that adress treatment of cleft palate and in particular the surgical treatment of this disease and of these many are retrospective studies. This review reinforces the importance of performing prospective studies with long-term outcomes to elucidate the effect of each protocol for obtaining optimal results.

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.

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.

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.

Diagnosis and management of urethro-cavernosal fistulas

2020 ◽  
Vol 13 (6) ◽  
pp. 398-401
Author(s):  
Jullet Han ◽  
Saum Ghodoussipour ◽  
Evgeniy I Kreydin ◽  
Leo Doumanian
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Surgical Approaches ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Objective: To present a case series of urethro-cavernosal fistulas evaluating their diagnostic work-up and management. Methods: A literature search was performed using key words including “urethro-cavernosal fistula,” “urethral fistula,” and “cavernosal fistula.” Results: In total 10 case reports were identified and reviewed for information regarding clinical diagnosis, management, and long-term outcomes including success rates and complications. Conclusion: Urethro-cavernosal fistula is a rare urological condition. With few cases reported to date, there is considerable variation in diagnostic work-up and management. Both conservative and surgical approaches can be utilized in the management of urethro-cavernosal fistulas with good long-term outcomes. Level of evidence: Not applicable for this multicentre audit.

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.

scholarly journals A Jehovah’s Witness with Acute Myeloid Leukemia Successfully Treated with an Epigenetic Drug, Azacitidine: A Clue for Development of Anti-AML Therapy Requiring Minimum Blood Transfusions

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Yumi Yamamoto ◽  
Akihito Kawashima ◽  
Eri Kashiwagi ◽  
Kiyoyuki Ogata
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Supportive Therapy ◽  
Blood Transfusions ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Epigenetic Drug ◽  
Acute Myeloid

Therapy for acute leukemia in Jehovah’s Witnesses patients is very challenging because of their refusal to accept blood transfusions, a fundamental supportive therapy for this disease. These patients are often denied treatment for fear of treatment-related death. We present the first Jehovah’s Witness patient with acute myeloid leukemia (AML) treated successfully with azacitidine. After achieving complete remission (CR) with one course of azacitidine therapy, the patient received conventional postremission chemotherapy and remained in CR. In the case of patients who accept blood transfusions, there are reports indicating the treatment of AML patients with azacitidine. In these reports, azacitidine therapy was less toxic, including hematoxicity, compared with conventional chemotherapy. The CR rate in azacitidine-treated patients was inadequate; however, some characteristics could be useful in predicting azacitidine responders. The present case is useful for treating Jehovah’s Witnesses patients with AML and provides a clue for anti-AML therapy requiring minimum blood transfusions.

Long-Term Outcomes of Reoperation for Bleeding After Cardiac Surgery

2020 ◽  
Author(s):  
James A. Brown ◽  
Arman Kilic ◽  
Edgar Aranda-Michel ◽  
Forozan Navid ◽  
Derek Serna-Gallegos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Long Term Outcomes
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