How to approach major surgery where patients refuse blood transfusion (including Jehovah's Witnesses)

Abstract

Jehovah's Witnesses do not permit the use of allogeneic blood products. An increasing number of patients are refusing blood transfusion for non-religious reasons. In addition, blood stores are decreasing, and costs are increasing. Transfusion avoidance strategies are, therefore, desirable.Bloodless surgery refers to the co-ordinated peri-operative care of patients aiming to avoid blood transfusion, and improve patient outcomes. These principles are likely to gain popularity, and become standard practice for all patients.This review offers a practical approach to the surgical management of Jehovah's Witnesses, and an introduction to the principles of bloodless surgery that can be applied to the management of all patients.

Acute Normovolemic Hemodilution: A Practical Approach

“…When ANH is performed with patients who have restrictions on receiving blood transfusions for religious reasons, in the case of a Jehovah's Witness for example, a closed circuit system should be prepared, and some modifications are necessary [35][36][37].…”

Bloodless Medicine and Surgery

“…15 v. 29 (New English Bible) 13,14 Denton Cooley, widely regarded as the founding father of modern bloodless surgery, performed the first bloodless open-heart surgery on one of Jehovah's Witnesses on May 18 th , 1962. 2,12 In 1977 Ott and Cooley published a pioneer report of 542 open-heart surgeries without allogeneic blood transfusion in patients ranging in age from one day to 89 years, 15 demonstrating that the "impossible" was possible -and safer.…”

Tratamento cirúrgico de alopecia cicatricial no couro cabeludo e defeito da calota craniana em criança, sem transfusões de sangue

“…Os cirurgiões estão cônscios não somente dos riscos associados às transfusões de sangue, mas também dos custos e suprimentos restritos das bolsas de sangue. Também há pacientes que devido a vários motivos, inclusive religiosos, não aceitam transfusões de sangue 2 . Tais fatores têm contribuído para a popularização de estratégias terapêuticas alternativas às transfusões de sangue, comumente denominadas de "gerenciamento e conservação do sangue" 1 .…”