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

Jung, Jaewoong; Lee, Misoon; Kang, Youjin; Cho, Sung-Hwan

doi:10.21037/apm-21-3013

Cited by 3 publications

(1 citation statement)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although only a symptomatic treatment for anemia, the benefit for surgical patients is well known, and administration of EPO is recommended by the 2017 EACTS guidelines especially in the preoperative setting [18]. There are advanced protocols for the treatment of anemic patients that show gradual improvement as early as 1-2 weeks after initiation [2][3][4]10,[19][20][21]. This should not only apply to Jehovah's Witnesses, but should be generally practiced in all anemic patients [22].…”

Section: Discussionmentioning

confidence: 99%

Everyday Cardiac Surgery in Jehovah‘s Witnesses of Typically Advanced Age: Clinical Outcome and Matched Comparison

Hartrumpf

Kuehnel

Ostovar

et al. 2023

JCM

View full text Add to dashboard Cite

Background and Objectives: Jehovah’s Witnesses (JW) reject the transfusion of blood components based on their religious beliefs, even if they are in danger of harm or death. In cardiac surgery, this significantly reduces the margin of safety and leads to ethical conflicts. Informed consent should be carefully documented and the patient’s family should be involved. This study aims to compare the postoperative course of JW who underwent major cardiac surgery with a similar population of non-Witnesses (NW). Patients and Methods: Demographic, procedural, and postoperative data of all consecutive JW who underwent cardiac surgery at our institution were obtained from the records. They were compared with a propensity-score-matched group of NW. Anemic JW were treated with erythropoietin and/or iron as needed. Cardiac surgery was performed by experienced surgeons using median sternotomy and cardiopulmonary bypass. Common blood-sparing techniques were routinely used. Periprocedural morbidity and mortality were statistically evaluated for both groups. Results: A total of 32 JW and 64 NW were part of the matched dataset, showing no demographic or procedural differences. EPO was used preoperatively in 34.4% and postoperatively in 15.6% of JW but not in NW. Preoperative hemoglobin levels were similar (JW, 8.09 ± 0.99 mmol/L; NW, 8.18 ± 1.06; p = 0.683). JW did not receive any transfusions except for one who revoked, while NW transfusion rates were 2.5 ± 3.1 units for red cells (p < 0.001) and 0.3 ± 0.8 for platelets (p = 0.018). Postoperative levels differed significantly for hemoglobin (JW, 6.05 ± 1.00 mmol/L; NW, 6.88 ± 0.87; p < 0.001), and hematocrit (JW, 0.29 ± 0.04; NW, 0.33 ± 0.04; p < 0.001) but not for creatinine. Early mortality was similar (JW, 6.3%; NW, 4.7%; p = 0.745). There were more pacemakers and pneumonias in JW, while all other postoperative conditions were not different. Conclusions: Real-world data indicate that Jehovah’s Witnesses can safely undergo cardiac surgery provided that patients are preconditioned and treated by experienced surgeons who use blood-saving strategies. Postoperative anemia is observed but does not translate into a worse clinical outcome. This is consistent with other studies. Finally, the results of this study suggest that all patients should benefit from optimal pretreatment and blood-sparing strategies in cardiac surgery, not just Jehovah’s Witnesses.

show abstract

Section: Discussionmentioning

confidence: 99%

Everyday Cardiac Surgery in Jehovah‘s Witnesses of Typically Advanced Age: Clinical Outcome and Matched Comparison

Hartrumpf

Kuehnel

Ostovar

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

Everyday Cardiac Surgery in Jehovah‘s Witnesses of Typically Advanced Age: Clinical Outcome and Matched Comparison

Hartrumpf¹,

Kuehnel²,

Ostovar³

et al. 2023

Preprint

View full text Add to dashboard Cite

Background and Objectives: Jehovah's Witnesses (JW) reject the transfusion of blood components based on their religious beliefs even if they are in danger of harm or death. In cardiac surgery, this significantly reduces the margin of safety and leads to ethical conflicts. Informed consent should be carefully documented and the patient's family should be involved. This study aims to compare the postoperative course of JW who underwent major cardiac surgery with a similar population of non-Witnesses (NW). Patients and Methods: Demographic, procedural, and postoperative data of all consecutive JW who underwent cardiac surgery at our institution were obtained from the records. They were compared with a propensity score matched group of NW. Anemic JW were treated with erythropoietin and/or iron as needed. Cardiac surgery was performed by experienced surgeons using median sternotomy and cardiopulmonary bypass. Common blood-sparing techniques were routinely used. Periprocedural morbidity and mortality were statistically evaluated for both groups. Results: 32 JW and 64 NW were part of the matched dataset showing no demographic or procedural differences. EPO was used preoperatively in 34.4% and postoperatively in 15.6% of JW but not in NW. Preoperative hemoglobin levels were similar (JW, 8.09±0.99 mmol/l; NW, 8.18±1.06; p=0.683). JW did not receive any transfusions except for one who revoked, while NW transfusion rates were 2.5±3.1 units for red cells (p&lt;0.001) and 0.3±0.8 for platelets (p=0.018). Postoperative levels differed significantly for hemoglobin (JW, 6.05±1.00 mmol/l; NW, 6.88±0.87; p&lt;0.001), and hematocrit (JW, 0.29±0.04; NW, 0.33±0.04; p&lt;0.001) but not for creatinine. Early mortality was similar (JW, 6.3%; NW, 4.7%; p=0.745). There were more pacemakers and pneumonias in JW, while all other postoperative conditions were not different. Conclusions: Real-world data indicate that Jehovah's Witnesses can safely undergo cardiac surgery provided that patients are preconditioned and treated by experienced surgeons who use blood-saving strategies. Postoperative anemia is observed but does not translate into a worse clinical outcome. This is consistent with other studies.

show abstract

Bloodless Treatment of Jehovah’s Witness Patients with Lymphoma and Multiple Myeloma

Kim,

Jeong,

Yoon

et al. 2023

Korean J Med

View full text Add to dashboard Cite

Background/Aims: Jehovah’s Witnesses refuse blood transfusions for religious reasons. Soonchunhyang University Hospital Seoul has operated a bloodless treatment center since 2000, and a database of bloodless treatment patients has been created. This study aimed to analyze the bloodless treatment outcomes of lymphoma and multiple myeloma patients.Methods: We retrospectively analyzed data of patients diagnosed with lymphoma (22 patients) or multiple myeloma (seven patients) who were treated bloodlessly at Soonchunhyang University Hospital Seoul from 2006 to 2021.Results: The 2-year survival rate for lymphoma patients was 66.6%, with 22.7% dying within 6 months of diagnosis. Those who died early (within 6 months) had a median hemoglobin level of 5.5 g/dL and a median platelet count of 50,142/µL. Dyspnea due to anemia was the most common symptom reported by patients at the end of life. Patients with multiple myeloma had a median survival of 60.3 months and a 2-year survival rate of 57.1%. Although three of the seven multiple myeloma patients were eligible for autologous stem cell transplantation, they were treated with chemotherapy only due to limitations of the bloodless treatment. The drug type and intensity were adjusted due to hematological toxicities in 71.4% of multiple myeloma patients.Conclusions: A significant proportion of patients completed their planned course of chemotherapy and achieved long-term survival. The treatments of some patients were adjusted due to the use of bloodless treatment at the initial chemotherapy session, which affected their response to treatment.

show abstract

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

Cited by 3 publications

References 15 publications

Everyday Cardiac Surgery in Jehovah‘s Witnesses of Typically Advanced Age: Clinical Outcome and Matched Comparison

Everyday Cardiac Surgery in Jehovah‘s Witnesses of Typically Advanced Age: Clinical Outcome and Matched Comparison

Everyday Cardiac Surgery in Jehovah‘s Witnesses of Typically Advanced Age: Clinical Outcome and Matched Comparison

Bloodless Treatment of Jehovah’s Witness Patients with Lymphoma and Multiple Myeloma

Contact Info

Product

Resources

About