Greetings all,

We have a Jehovah’s Witness patient who’s having surgery in a couple of days. Her Hemoglobin is constantly dropping and she refuses blood transfusion as treatment.

I would like to know how other facilities deal with such cases.

I need as many replies as possible...

Thanks!!!

We have a Bloodless Program here for patients such as yours. We usually identify them as Bloodless by putting a bloodless wristband on them, putting a bloodless sticker on their chart, and a sign over their bed to make everyone aware. We also make sure they have a signed Health Care Proxy and we get their wishes documented on a Blood Refusal form so that we are covered legally. We put a bloodless "code" in our Lab computer system so that nobody in the Lab inadvertently releases any blood products. Then we get a Hematologist consult ordered STAT; they usually do an anemia workup to look at iron levels, B12, etc. The hematologist will then usually get the patient on IV iron and Procrit to boost their red cell production. We also use bloodless techniques, such as cell saver (there is a special Jehovah's Witness protocol where their blood stays in a continuous circuit which is acceptable to most of them), interventional radiology techniques (such as embolization to stop active bleeding). We try to limit blood draws as much as possible so that we don't deplete what they have left.

Hope some of this is helpful to you.

Many JW patients will accept their own blood via a cell saver because it is never exposed to the air. Our facility usually will work with each individual patient and work out a customized plan for their care as it pertains to blood products. Some JW's will accept blood products, and some will not. I've heard of things like "If it's yellow, yes, if it's red, no" but that doesn't necessarily pertain to all cases. It is very much an individual's choice. The few JW's we've worked with say that members that accept blood products will not be ostracized as it is widely believed. I would say to have the cell saver ready, make sure that the patient's directives are widely known and present on the chart, and consult with the surgeon to discuss other bloodless options (IV therapy, hemodilution, etc.).