scholarly journals How to approach orthognathic surgery in patients who refuse blood transfusion

2020 ◽  
Vol 47 (5) ◽  
pp. 404-410
Author(s):  
Sang Hwan Lee ◽  
Dong Gyu Kim ◽  
Ho Seong Shin
Keyword(s):  
Blood Transfusion ◽  
Orthognathic Surgery ◽  
Blood Transfusions ◽  
Recombinant Erythropoietin ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Hypotensive Anesthesia ◽  
Normovolemic Hemodilution ◽  
Surgery Center ◽  
Bloodless Surgery

Background Some patients who need surgery refuse a blood transfusion because of their religious beliefs or concerns about blood-borne infections. In recent years, bloodless surgery has been performed successfully in many procedures, and is therefore of increasing interest in orthognathic surgery.Methods Ten Jehovah’s Witnesses who visited our bloodless surgery center for orthognathic surgery participated in this study. To maintain hemoglobin (Hb) levels above 10 g/dL before surgery, recombinant erythropoietin (rEPO) was subcutaneously administered and iron supplements were intravenously administered. During surgery, acute normovolemic hemodilution (ANH) and induced hypotensive anesthesia were used. To elevate the Hb levels to >10 g/dL after surgery, a similar method to the preoperative approach was used.Results The 10 patients comprised three men and seven women. Their average Hb level at the first visit was 11.1 g/dL. With treatment according to our protocol, the average preoperative Hb level rose to 12.01 g/dL, and the average Hb level on postoperative day 1 was 10.01 g/dL. No patients needed a blood transfusion, and all patients were discharged without any complications.Conclusions This study presents a way to manage patients who refuse blood transfusions while undergoing orthognathic surgery. rEPO and iron supplementation were used to maintain Hb levels above 10 g/dL. During surgery, blood loss was minimized by a meticulous procedure and induced hypotensive anesthesia, and intravascular volume was maintained by ANH. Our practical approach to orthognathic surgery for Jehovah’s Witnesses can be applied to the management of all patients who refuse blood transfusions.

Bloodless surgery and gynecological patients among Jehovah’s Witnesses

2021 ◽  
Vol 86 (2) ◽  
pp. 110-113
Author(s):  
Milan Kudela ◽  
◽  
Radovan Pilka ◽  
Petr Dzvinčuk ◽  
Radim Marek ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Gynecologic Surgery ◽  
Jehovah’S Witnesses ◽  
Ethical Problems ◽  
Jehovah's Witnesses ◽  
Estimated Blood Loss ◽  
Risk Patients ◽  
Bloodless Surgery ◽  
Excessive Blood Loss

Overview Objective: The aim of this research is to present our experiences with the surgical treatment of gynecological patients among Jehovah’s Witnesses. Moreover, the medical, moral, and ethical problems in this regard have been highlighted. Methods: 75 Jehovah’s Witnesses patients were operated on for various benign and malignant gynecological diseases between 2007 and 2018. All of these patients were operated on according to the rules of blood-sparing surgery. Results: The operations were assessed according to the dia­gnosis, mode of surgery, estimated blood loss, and disease outcome. Excessive blood loss did not occur during any of these operations, and the estimated blood loss for the same procedure was 10 to 550 mL. Conclusion: Jehovah’s Witnesses gynecological patients is a group of high-risk patients because they refuse to undergo blood transfusion. Nevertheless, the principles of blood-sparing surgery should be applied to not only Jehovah’s Witnesses patients but also to all patients in general. Even if a blood transfusion is the last resort to solve issues pertaining to excessive blood loss during complicated operations, the said procedure always carries certain risks. Therefore, blood transfusion should be performed only on rare occasions. Jehovah’s Witnesses patients categorically refuse blood transfusion even if it is the only way to save one’s life. Even though the legislation of the Czech Republic deals with this problem, there are other moral and ethical aspects that need to be addressed in this regard. Keywords: bloodless surgery – Gynecologic surgery – Jehovah’s Witnesses – legislation – moral and ethical problems

scholarly journals Death of a child because of refusal to hemotranfusion on religious motives: legal aspect

2020 ◽  
pp. 105-110
Author(s):  
O. Parilov
Keyword(s):  
Blood Transfusion ◽  
Russian Federation ◽  
Legal Aspect ◽  
Blood Transfusions ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Death Of A Child ◽  
The Russian Federation ◽  
Religious Reasons

In the Russian Federation in recent years, dozens of children have died due to the fact that they did not receive blood transfusions on time, when it was urgently necessary for medical reasons. This happened because their parents or legal representatives — Jehovah’s Witnesses are principled opponents of blood transfusion for religious reasons. The philosophical (bioethical), theological aspects are studied, but special attention is paid to the legal aspect of the problem.

Biomedical Ethics for Jehovah’s Witnesses and Patient Blood Management

2021 ◽  
Vol 27 (2) ◽  
pp. 49-54
Author(s):  
Sunghwan Cho
Keyword(s):  
Religious Beliefs ◽  
Biomedical Ethics ◽  
Blood Transfusions ◽  
Patient Blood Management ◽  
Blood Management ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Religious People

Jehovah’s Witnesses refuse blood transfusions according to religious beliefs, and for this reason, most hospitals and doctors have refused their treatment. There are more than 100,000 religious people in Korea, but there are few bloodless centers that can receive their treatment. So, the number of Jehovah’s Witnesses patients visiting bloodless centers in Soonchunhyang University Bucheon Hospital has been increasing every year. Despite this situation, no legal or medical countermeasure has yet been proposed against them. Therefore, I would like to take a bioethical approach based on “principles of biomedical ethics” and introduce “patient blood management” which is currently spreading in advanced medical countries.

Early Experiences With PEGylated Carboxyhemoglobin Bovine in Anemic Jehovah’s Witnesses: A Case Series and Review of the Literature

2018 ◽  
Vol 33 (3) ◽  
pp. 372-377 ◽  
Author(s):  
Sean McConachie ◽  
Krista Wahby ◽  
Zinah Almadrahi ◽  
Sheila Wilhelm
Keyword(s):  
Case Series ◽  
Stable Condition ◽  
Complex Nature ◽  
Blood Transfusions ◽  
Oxygen Carriers ◽  
Jehovah’S Witnesses ◽  
Clinical Safety ◽  
Jehovah's Witnesses ◽  
Pharmacologic Management ◽  
Oxygen Carrying Capacity

Jehovah’s Witnesses (JW) represent a complex patient population due to their refusal to accept blood transfusions on religious grounds. Pharmacologic management of anemic JW patients is limited to stimulation of hematopoiesis by iron and erythropoietin supplementation and reduction of blood loss by prothrombin complex concentrates (PCCs). Hemoglobin-based oxygen carriers (HBOCs) represent the only pharmacologic modality for JW patients capable of acutely increasing a patient’s oxygen carrying capacity in the setting of organ failure, yet clinical safety and efficacy data are lacking in this population. We report 3 cases in which the HBOC, PEGylated carboxyhemoglobin bovine (Sanguinate®), was requested under emergent circumstances for severely anemic (hemoglobin <5 g/dL) JW patients who refused blood transfusions. Two patients received PEGylated carboxyhemoglobin infusions for severe anemia, while the third patient died prior to receiving the medication. One patient who received Sanguinate died after 5 units of medication. The other patient’s hemoglobin recovered and she was discharged in stable condition. This series demonstrates the complex nature of the critically anemic JW population and highlights the clinical considerations of using HBOCs in clinical practice and the critical need for further research before they can be broadly recommended.

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