Optimising bloodless cardiovascular surgery for Jehovah’s Witnesses and beyond

Abstract

Emerging evidence suggests surgical outcomes of patients undergoing cardiovascular surgery that refuse autologous transfusion is comparable to those who accept whole blood product transfusions. There are several methods that can be used to minimize blood loss during cardiovascular surgery. These methods can be categorised into pharmacological measures, including the use of erythropoietin, iron and tranexamic acid, surgical techniques, like the use of polysaccharide haemostat, and devices such as those used in acute normovolaemic haemodilution. More prospective studies with stricter protocols are required to assess surgical outcomes in bloodless cardiac surgery as well as further research into the long-term outcomes of bloodless cardiovascular surgery patients. This review summarizes current evidence on the use of pre-, intra-, and post-operative strategies aimed at the subset of patients who refuse blood transfusion, for example Jehovah's Witnesses.

Patient blood management when blood is not an option: a report of two cases

“…PBM has been developed to treat patients with evidence-based and multidimensional approaches. Many experiences of treatment without transfusion, including cardiac surgery (16,17), liver transplantation (7,11) and lung transplantation (18), have accumulated through treatment of JW patients, and concept such as PBM and "bloodless medicine and surgery" have been spreading around the world. Blood transfusion is still one of the best treatments if used appropriately, but is no longer the only treatment option for some patients.…”