Learning objectives
- Understand the beliefs of Jehovah’s Witness patients
- Perioperative management of Jehovah’s Witness patients
Definition and mechanisms
- Jehovah’s Witnesses believe that the Bible prohibits Christians from accepting blood transfusions, even when necessary to prevent morbidity/mortality
- They also believe that blood that has been removed from the body is ‘unclean’ and should be disposed of
- That means that their beliefs prevent them from accepting transfusion of whole blood or its primary components and not accepting blood transfusions and not donating or storing their own blood for transfusion
- It is unlawful to administer a blood transfusion to a Jehovah’s Witness who has expressly forbidden it
- Preoperative planning, preparation, and an experienced team are essential for a successful outcome
- Blood-free major surgery in the Jehovah’s Witness patient presents a challenge to the anesthetic and surgical team
Acceptability of blood products and transfusion-related procedures
Unacceptable Whole blood
Packed red cells
Plasma
Autologous pre-donation
Acceptable Cardiopulmonary bypass
Renal dialysis
Acute hypervolemic hemodilution
Recombinant erythropoietin
Recombinant factor VIIa
May be acceptable Platelets
Clotting factors
Albumin
Immunoglobulins
Epidural blood patch
Cell saver
Management
Suggested reading
- Lawson, T., Ralph, C., 2015. Perioperative Jehovah’s Witnesses: a review. British Journal of Anaesthesia 115, 676–687.
- Milligan LC, Bellamy MC. Anaesthesia and critical care of Jehovah’s Witnesses. Continuing Education in Anaesthesia Critical Care & Pain. 2004/ 4;(2); 35-39.
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