BACKGROUND: Jehovah's Witnesses are widely known for their prohibition on the acceptance of blood transfusion. Such refusal serves as a potential obstacle to optimal therapeutic intervention among critically injured Jehovah's Witnesses. As such, care of these patients requires an aggressive and multidisciplinary approach to therapy. METHODS: A review of the pertinent English language literature. RESULTS: Jehovah's Witnesses exercise the right of any adult with capacity to refuse medical treatment and often carry advance directive cards indicating their incontrovertible refusal of blood. Despite their belief regarding transfusion, Jehovah's Witnesses do not have a higher mortality rate after traumatic injury or surgery. Transfusion requirements are often overestimated. Increased morbidity and mortality is rarely observed in patients with a hemoglobin concentration >7 g/dL, and the acute hemoglobin threshold for cardiovascular collapse may be as low as 3 g/dL to 5 g/dL. There are many modalities to treat the Jehovah's Witness patient with acute blood loss. Treatment with recombinant human erythropoietin, albumin, and recombinant activated Factor VIIa have all been used with success. Autologous autotransfusion and isovolemic hemodilution can also be used to treat patients who refuse transfusion. Hemoglobin-based oxygen carriers may play a future role as intravascular volume expanders in lieu of transfusion of red blood cell concentrates. CONCLUSION: There are many treatment modalities available to assist in the care of Jehovah's Witness patients, especially since their beliefs on the intricacies of the Blood Ban appear to be in flux.
BACKGROUND: Jehovah's Witnesses are widely known for their prohibition on the acceptance of blood transfusion. Such refusal serves as a potential obstacle to optimal therapeutic intervention among critically injured Jehovah's Witnesses. As such, care of these patients requires an aggressive and multidisciplinary approach to therapy. METHODS: A review of the pertinent English language literature. RESULTS: Jehovah's Witnesses exercise the right of any adult with capacity to refuse medical treatment and often carry advance directive cards indicating their incontrovertible refusal of blood. Despite their belief regarding transfusion, Jehovah's Witnesses do not have a higher mortality rate after traumatic injury or surgery. Transfusion requirements are often overestimated. Increased morbidity and mortality is rarely observed in patients with a hemoglobin concentration >7 g/dL, and the acute hemoglobin threshold for cardiovascular collapse may be as low as 3 g/dL to 5 g/dL. There are many modalities to treat the Jehovah's Witnesspatient with acute blood loss. Treatment with recombinant humanerythropoietin, albumin, and recombinant activated Factor VIIa have all been used with success. Autologous autotransfusion and isovolemic hemodilution can also be used to treat patients who refuse transfusion. Hemoglobin-based oxygen carriers may play a future role as intravascular volume expanders in lieu of transfusion of red blood cell concentrates. CONCLUSION: There are many treatment modalities available to assist in the care of Jehovah's Witnesspatients, especially since their beliefs on the intricacies of the Blood Ban appear to be in flux.
Authors: Ashraf Selim; Charles U Nottingham; Nadya E York; Casey A Dauw; Michael S Borofsky; Ronald S Boris; James E Lingeman Journal: Int Urol Nephrol Date: 2019-11-19 Impact factor: 2.370
Authors: Claude D Vaislic; Nicolas Dalibon; Oliver Ponzio; Maguette Ba; Eric Jugan; Franck Lagneau; Philippe Abbas; Yves Olliver; Didier Gaillard; Francois Baget; Michel Sportiche; Antoine Chedid; Georges Chaoul; Philippe Maribas; Christiane Dupuy; Bruno Robine; Nicolas Kasanin; Herve Michon; Jean-Michel Ruat; Michel Habis; Touhami Bouharaoua Journal: J Cardiothorac Surg Date: 2012-09-27 Impact factor: 1.637