if there is bleeding patient which is AB group , and the doctor requested for AB plasma to transfuse , while my stock is Zero, what can i do?

I would give group A before group B, because the anti-B in the group A FFP tends to be weaker than the anti-A in the group B FFP.

I would give group A before group B, because the anti-B in the group A FFP tends to be weaker than the anti-A in the group B FFP.

this is what i believe in case of PRBC transfusion , while in case of plasma transfusion , only we can issue AB

this is what i believe in case of PRBC transfusion , while in case of plasma transfusion , only we can issue AB

I'm curious, if this is the case what do you do for platelet transfusions? Surely you don't have an unlimited supply of AB platelets.

You could also have your pharmacy stock activated Factor VII (VIIa) or prothrombin complex. The FVIIa is supposed to work really well, but if used inappriately can cause some serious thrombosis. If they are using red cell products, you might transfuse ABO identical to what you are infusing - unless you have a real good supply of group AB blood.

A recent talk on the support of Jehovah's Witness patients that refuse most blood products said that they would usually take cryoprecipitate and that it did quite a bit to help stop the bleeding. I need to contact the speaker to discuss this as a possible treatment for hemorrhaging (non-JW) patients at small hospitals in remote areas that can't stock a lot of AB FFP. Cryo is usually given without concern for ABO or Rh. Ours is in pools of 5 uints.

Mabel,

I am curious to know if the speaker you refered to gave a reason why Jehovah's Witnesses would take cryo. As I understand it, they refuse all blood components, and cryo does come from blood. I had not heard this before.

Mabel -

I,too am curious. Please let us know if you are able to contact the speaker and clarify the Jehovah's Witness and Cryo issue. Thanks!

Donna

A recent talk on the support of Jehovah's Witness patients that refuse most blood products said that they would usually take cryoprecipitate and that it did quite a bit to help stop the bleeding. I need to contact the speaker to discuss this as a possible treatment for hemorrhaging (non-JW) patients at small hospitals in remote areas that can't stock a lot of AB FFP. Cryo is usually given without concern for ABO or Rh. Ours is in pools of 5 uints.

Is it possible that he meant clotting factor concentrates since they have undergone further manufacture? I have trouble believing that a Jehovah's Witness would take cryo.

I was originally surprised at this too, but I have it in some written material as well as from this physician speaker. Cryo is pretty clearly a matter of conscience just like IVIg, RhIG etc. They consider it a fraction, not a blood product. This speaker felt that it had been life-saving at times. There are JW hospital liaisons available in many communities to answer BBer's questions.

What I have found is consistent with the following (I am sure there is a more "official" source on line):

Prohibited procedures

The following medical procedures are prohibited:

• Transfusion of allogeneic whole blood, or of its constituents of red cells, white cells, platelets or plasma.[21]
  
• Transfusions of pre-operative self-donated (autologous) blood.[18]
  

Permitted procedures and products

The following procedures and products are not prohibited, and are left to the decision of individual members:[22]

• Blood donation strictly for purpose of further fractionation of red cells, white cells, platelets or plasma for either allogeneic or autologous transfusion.[21][23]
  
• Transfusions of autologous blood part of a "current therapy".[18]
  
• Hemodilution, a modified technique in which equipment is arranged in a circuit that is constantly linked to the patient's circulatory system.[18]
  
• Intraoperative blood salvage (autologous) or cell-saver scavenging, a method of picking up blood that has spilled from the circulatory system into an open wound, cleaning and re-infusing it.[18]
  
• Heart-Lung Machine, a method in which blood is diverted to an artificial heart-lung machine and directed back into the patient.[18]
  
• Dialysis, wherein blood circulates through a machine, is filtered and cleaned, then returned to the patient.[18]
  
• Epidural Blood Patch, consisting of a small amount of the patient's blood injected into the membrane surrounding the spinal cord.[18]
  
• Plasmapheresis, wherein blood is withdrawn and filtered, having the plasma removed and substituted, and returned to the patient.[18]
  
• Labeling or Tagging, blood is withdrawn, mixed with medicine, and then returned to the patient by transfusion.[17][18]
  
• Platelet Gel, blood is withdrawn and put into a solution rich in platelets and white blood cells.[18]
  
• Fractions from red blood cells:
  
  • Hemoglobin, the oxygen-carrying component of red blood cells.
    

  [*]Fractions from white blood cells:[21]

  • Interferons
    
  • Interleukins
    

  [*]Fractions from platelets:[21]

  • Platelet factor 4
    

  [*]Fractions from blood plasma:[21]

  • Albumin
    
  • Globulins
    
  • Cryoprecipitate
    
  • Cryosupernatant (cryo-poor plasma)[24]
    
  • Clotting factors, including Factor VIII and Factor IX derived from large quantities of stored blood
    
  • Wound healing factor
    

  [*]Erythropoietin (EPO).[21]

  [*]PolyHeme, a blood substitute solution of chemically modified human hemoglobin.[21]

  [*]Hemopure, a blood substitute solution of chemically stabilized bovine hemoglobin derived from cow's blood.[21]

http://en.wikipedia.org/wiki/Jehovah's_Witnesses_and_blood_transfusions#Permitted_procedures_and_products

Semantics, honestly!!

All of that aside.... we had a Jehovah's Witness patient all ready for a plasma exchange using 100% saline as replacement... when his religious leader walked into his room and told him he would absolutely go to hell if his blood left his body and returned.

I believe there is a lot (A LOT!) of variability in how they choose to obey this commandment, that it really needs to be managed on a case by case basis.

I was looking on-line for official JW info and stumbled on some discussion groups around the matter. Yes, there appears to be a large degree of individual choice but also a fairly strong tradition of leaders trying to convince believers to follow their more stringent stance. Peer pressure, it seems.

Another really interesting part of this speaker's presentation was the blood refusal form that they use. It includes a section for the parents of minors to sign recognizing that the medical providers are ethically bound to provide transfusion in some situations. They sign acknowledging that the transfusion will happen against the parents' wishes (the hospital promises to do everything reasonable to avoid the transfusion). BUT, this allows the hospital to proceed without going to court and the child becoming a ward of the state that can then make additional decisions about the child over which the parents have no control.

Here is the wording:

"Refusal of Blood transfusion for a minor. As the parent/guardian of a minor child I understand that the doctor(s) treating my child will make every effort to respect my beliefs regarding the transfusion of blood products as indicated above. However I also recognize that my child's physicians have a legal obligation not to withhold therapy they think is necessary to keep my child alive or to keep him/her from serious harm or permanent injury or disability. I understand therefore that, if the treating physician believes transfusion, after evaluating alternative non-blood medical management, is necessary to save my child's life, or to prevent serious irreversible harm, my child may be transfused although every effort will be made to avoid this."

Thanks, Mabel. That was very interesting about how some handle the situations involving a minor.

My experience also supports the comment that there is a wide variation on how the individuals interpret/obey the blood-related commandment.

Thanks for the extensive list and the consent, Mabel (my thanks button doesn't work?!).

I had a JW patient who accepted cryo on the basis that it was yellow (non-cellular?). If it was red, she didn't want it, so she asked to see the product before she would consent to infusion. Her daughter arrived on the scene prior to the start of the infusion, daughter got upset, and then mom refused the product. Guess that falls into the category of personal(???) choice (or personal choice once removed!).

Some of our JW patients will accept RhoGAM, some will not. Again...personal choice.

Edited July 16, 201114 yr by AMcCord

Interesting wording Mabel.

I have had two experiences of taking children before court in Australia where they are made a ward, but the wardship was specifically related to transfusion of blood or blood products only. Interestingly enough, the relief of one of the cases parents was palpable when the matter was taken out of their hands.

Another interesting case here in Ireland in the last couple of years - A Jehovah Witness agreed to a transfusion, but changed her mind at the penultimate moment. The doctors determined she was no longer capable of rational decision due to her condition and went ahead and transfused. The patient took the hospital and the doctors to court. The case came up recently and the decision to transfuse was upheld by the courts.

For adults we have a specific refusal of consent for transfusion for adults, but it doesn't go into a lot of detail about products etc. Maybe we need to look again at the issue. I will take it to the next Hospital Transfusion Committee meeting.

Cheers

Eoin

A recent talk on the support of Jehovah's Witness patients that refuse most blood products said that they would usually take cryoprecipitate and that it did quite a bit to help stop the bleeding. I need to contact the speaker to discuss this as a possible treatment for hemorrhaging (non-JW) patients at small hospitals in remote areas that can't stock a lot of AB FFP. Cryo is usually given without concern for ABO or Rh. Ours is in pools of 5 uints.

We are a small hospital in a remote and rural area and we get around this problem by only holding AB FFP/cryo in stock (we hold 16 units in total FFP and 8 of cyro). If we run out of AB FFP we switch over to cryo but iif they are receiving enough FFP for us to run out they should be also having cryo anyway.