Accept Blood Transfusion Research Articles

Pancreaticoduodenectomy after Neoadjuvant Therapy in a Jehovah's Witness with Locally Advanced Pancreatic Cancer: Case Report and Approach to Avoid Transfusion

Although the morbidity and mortality rates associated with pancreaticoduodenectomy (PD) have been improving over the past several decades, perioperative transfusions are often needed. Here, we review the preoperative planning and overall management of a Jehovah's Witness patient with locally advanced pancreatic cancer who would not accept blood transfusion. Management of this case is reviewed, along with the relevant literature regarding major surgery in the Jehovah's Witness population. The use of neoadjuvant chemoradiation was used successfully in locally advanced disease, allowing surgical resection. In addition, we outline a cogent strategy using pre-, intra-, and postoperative techniques to minimize blood loss and maintain hemoglobin at acceptable levels thereby preventing the need for transfusion. These strategies, once in place, may be able to reduce transfusions in all patients having major resections for malignancy.

Elective abdominal hysterectomy in Nigerian Jehovah's Witnesses

In a retrospective study at a university hospital, the perioperative morbidity associated with elective total abdominal hysterectomy in 23 Jehovah's Witnesses was compared with that of 46 non-Witness controls. The mean operative blood loss was significantly less, the procedure was lengthier and the average postoperative hospital stay was longer in the study than in the control group. Febrile morbidity was insignificantly more frequent among the study group (OR: 2.05, CI: 0.61 - 6.88) and there was no significant difference between the overall morbidity experienced by patients in both groups (study: 43.5% versus control: 39.1%; P = 0.73). The perioperative morbidity associated with elective abdominal hysterectomy in patients unwilling to accept blood transfusion does not justify the denial of this important gynaecological surgery when indicated. Gynaecologists in poor resource settings should consciously aim at providing 'bloodless' care for all their patients undergoing abdominal hysterectomy as this may translate to reduced blood loss and decreased need for blood transfusion.

U-turn on blood policy

Jehovah's Witnesses are now allowed to accept blood transfusions without facing excommunication from their faith. Following a secret meeting of the following's 12 member global governing body at their New York headquarters, a change in practice was decreed and blood transfusion was officially downgraded to a “non-disfellowshipping event.” Jehovah's Witnesses may now consent to and accept blood transfusions in life or death situations without facing expulsion from the movement. This is …

Fatal choices?

‘It is very distressing for staff to have to watch a woman bleed to death while (she is) refusing effective treatment.’ The latest Report of Confidential Enquiries into Maternal Deaths in the UK describes the cases of four women who died rather than accept blood transfusion. In one case the consultant anaesthetist became so upset that a colleague was asked to take over resuscitation.

Management of the Jehovah's Witness Oncology Patient: Perspective of the Transfusion Service.

Due to refusal of blood component transfusions, Jehovah's Witness patients with cancer present a challenge to oncologists who must find appropriate and acceptable treatments. In order to assess the morbidity and mortality that these patients suffer, a retrospective review was conducted of all 58 Jehovah's Witness patients treated at our center from October 1986 through February 1994. This study showed that (1) younger Jehovah's Witness patients or their parents were more likely to accept blood transfusion than older Jehovah's Witness patients, (2) considerable risk of acute morbidity and mortality occurred in patients who refused blood when blood transfusions were indicated, and (3) long-term prognosis may be worsened for some Jehovah's Witness patients due to limited treatment provided in those with anemia or with anticipated anemia.

Management of blood loss in Jehovah's Witnesses

Recombinant human erythropoietin helps but is expensive The Jehovah's Witness religion was founded in the late 1870s by Charles Russell in Pittsburgh, Pennsylvania. There are 5 million Jehovah's Witnesses worldwide and 125000 in the United Kingdom. Members of this sect do not accept blood transfusions, a stand based on passages from the Bible, such as this from Leviticus: (xvii) “As for any man who eats any sort of blood, I shall certainly set my face against the soul that is eating the blood, and I shall indeed cut him off from among his people.” Blood transfusion is interpreted as the eating of blood, and Jehovah's Witnesses believe that all hope of eternal life will be forfeited if transfusion is accepted. Autologous transfusion is also prohibited because they believe that once blood has left the body, it is then unclean. These prohibitions present ethical and clinical challenges to doctors who look after seriously ill or injured Jehovah's Witnesses and prompt a search for alternatives to blood. The courts have consistently upheld Jehovah's Witnesses' decisions to refuse transfusions on the grounds that any adult of sound mind has the right to determine what shall be done with his or her own body. Nevertheless, two thirds of European doctors working in intensive care units would give transfusions to an unconscious Jehovah's Witness …

Traumatically injured Jehovah's Witnesses: a sixteen-year experience of treatment and transfusion dilemmas at a level I trauma center.

Traumatically injured Jehovah's Witnesses pose difficult management problems because of their refusal to accept blood transfusions. This retrospective review of all inpatient traumatically injured Jehovah's Witnesses at a level I trauma center over the past 16 years revealed 77 patients with 92% blunt and 8% penetrating injuries. The primary physician was aware of their unique religious status in only 32% of cases. Transfusion was performed in only 4 (5.2%) cases even though it was desired by the physician in 11 (14%) cases. One transfusion was performed against the patient's will. One minor was transfused using a court order. Two transfusions were performed in the trauma room before the patients' religious status was known. Major changes in therapeutic plans were made as a result of the patients' Jehovah's Witness status in 10 cases (13%). Early knowledge of the patient's religious status is essential to optimize patient care.

Craniomaxillofacial Surgery in the Jehovahʼs Witness Patient

The reconstruction of severe craniofacial anomalies in patients who will not accept blood transfusions presents a considerable challenge to the craniofacial team. Traditionally, these patients have been refused major reconstructions, receiving no treatment or a highly compromised substitute. A management protocol was developed utilizing preoperative erythropoietin and ferrous sulfate therapy, intraoperative in-line normovolemic hemodilution, and meticulous intraoperative hemostasis which allows us to perform major craniomaxillofacial reconstructions in Jehovah's Witness patients without the use of homologous or predonated autologous blood transfusions.

The treatment of Jehovah's Witness patients

According to their religious dogma, Jehovah's Witnesses (JW) are unwilling to accept blood transfusions, even if their own lives are at stake. This belief puts physicians, who have no consistent legal norms to guide their behavior, in an ambiguous situation. To examine the socialization process regarding the development of norms under legal uncertainty, we asked medical students, house staff and faculty physicians to discuss their actions regarding each of four case simulations (one minor child, one incompetent adult, and two competent adults). In our sample, 84% of faculty and half of the respondents overall report having had personal experience with JWs. Despite patient or parental requests to the contrary, physicians were most likely to transfuse the child (80%), followed by the imcompetent adult (63%) and the two competent adults (25 and 15%). This ordering reflects the consistency of court decisions. In addition, the physicians' decisions regarding whether or not to transfuse did not vary with either their experience with JWs or level of training; however, experienced physicians appeared to learn to take precautions to protect themselves and their hospital from legal action. The study also indicates lack of formal medical education as an information source from which medical students learn about this ethical problem.

Cardiovascular Surgery in Jehovah's Witnesses

Jehovah's Witnesses who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report a 20-year experience with a consecutive series of 542 Jehovah's Witness patients ranging in age from 1 day to 89 years who underwent operation. Early mortality (within 30 days after operation) was 9.4%. In 362 patients requiring temporary cardiopulmonary bypass, early mortality was 10.7%. Mortality was 13.5% among 126 patients who had single- or double-valve replacement. The only deaths among patients who had aortic valve replacement or repair of a ventricular septal defect occurred in those who had some serious complication before operation. Preoperative or postoperative anemia was a contributing factor in 12 deaths, and loss of blood was the direct cause of three deaths. Cardiovascular operations can be performed safely without blood transfusion.

Blood Program in World War II. Medical Department, United States Army

The younger generation of clinicians and pathologists accept blood transfusion and the accumulated relevant information as an obvious part of current medical knowledge. But it was only in World War II that the value of whole-blood and plasma transfusions became so intensely and clearly demonstrated. In World War II, compared with the 1914-1918 war, the mortality rate of wounded men who reached forward hospitals alive was more than halved. The liberal use of blood and plasma played a major role in achieving this reduction. Under the stress of war, the problems of collection and distribution, of laboratory and clinical techniques, of indications and uses, loomed urgent, vast, inexorable. It was the stress of war which enabled us to make such enormous progress in medical science. The story of the blood program in World War II is admirably told in this latest volume of the history of the Medical Department of