Cell salvage for obstetric patients who decline blood transfusion – a national survey

Abstract

Dear Sir, Parturients who decline blood transfusion are encountered and managed in all UK obstetric units. The majority are Jehovah’s witnesses (JWs) who refuse transfusion of blood and it’s major components due to religious belief, even when transfusion would be life saving. Major obstetric haemorrhage remains a leading cause of peripartum morbidity and mortality (Centre for Maternal and Child Enquiries, 2011). Refusal of blood products is associated with a six times increased risk for maternal death, and a 130 times increased risk for death due to obstetric haemorrhage (Van Wolfswinkel et al. 2009). This risk is greatest when operative delivery is required. There are many guidelines on the management of JW patients presenting for surgery. Specific to obstetrics is the recently updated care plan produced by the Hospital Information Services for Jehovah’s Witnesses (2011). Guidance universally advocates the use of cell salvage. The acceptability of autologous transfusion and the various forms of perioperative cell salvage is a personal decision for each JW. Some may specifically request that the system be set up to allow for continuous connectivity. This requires the system to be fully primed and the reinfusion bag to be connected to the patient via a cannula throughout (UK Cell Salvage Action Group, 2008). In this way, the JW’s blood does not lose continuity with the circulation. When no such specific request is received, cell salvage may be used in the usual way. Cell salvage can usually be organised for elective surgery, but the challenge is in providing a service to JW parturients when obstetric surgery is often emergency in nature, out-ofhours and haemorrhage rapid. This difficulty is exacerbated when obstetric theatres lie remote from a hospital’s main theatre complex. Significant resources in terms of equipment, training and personnel are required and this is unlikely to be available in all units. We sought to establish current UK obstetric cell salvage clinical practice when managing JWs. The survey was approved by the Obstetric Anaesthesia Association (OAA) Survey Subcommittee and subsequently distributed in December 2011 to all registered obstetric lead consultant anaesthetists through the OAA electronic survey