Information for patients who do not accept transfusions
Information for clinical staff
- Every patient has a right to be treated with respect, and staff must be sensitive to their individual needs, acknowledging their values, beliefs and cultural background.
- Clinical practitioners must be aware of Jehovah’s Witness patients’ beliefs in relation to receiving blood or blood products and of the non-blood, medical alternatives to transfusion that may be applicable.
- Jehovah’s Witnesses are encouraged to carry a document at all times which details their wishes about medical care. Staff must take full note of this document. They must ensure also that the patient signs the appropriate form indicating his/her refusal to receive blood or blood components.
- Individual Jehovah’s Witnesses may accept treatments such as dialysis, cardiopulmonary bypass, organ transplants or plasma derivatives.
- It is essential that each Jehovah’s Witness patient who is competent is given the opportunity to discuss treatment options with a responsible doctor under a guarantee of strict clinical confidentiality.
- It is essential that any agreement to preserve total clinical confidentiality is strictly honoured.
Elective surgery
At time of referral (surgical out-patient department)
Check full blood count. Correct any haematinic deficiency (B12, folate, iron) and arrange further appropriate investigation.
If the procedure and the patient’s condition are such that the clinician would normally request blood to be crossmatched, discuss with patient, parents or guardian which of the available and appropriate blood-sparing options or alternatives would be acceptable to them, e.g. cell salvage, acute normovolaemic haemodilution, erythropoeitin, fibrin sealant or albumin.
Six weeks preoperative:
|
Adults:
| Oral iron |
Children:
| 1−5 years: sodium feredate sugar-free
elixir 27.5 mg Fe/5 ml
| 2.5 ml tid |
| | 6−12 years:sodium feredate sugar-free
elixir 27.5 mg Fe/5 ml
| 5 ml tid |
10 days preoperative
to 5 days post-operative:
| Erythropoetin if the anticipated blood loss > 15−20% blood volume.
|
7 days preoperative:
| Stop NSAID and aspirin. |
3 days preoperative:
| Stop warfarin where possible (see Table 7). |
At operation:
| Use blood conservation approaches (see Intra- and post-operative blood conservation), e.g. optimise anaesthetic technique − hypotension, hypothermia. Maximise haemostasis: surgical, antifibrinolytics, fibrin sealant. Conserve blood use: ANH, intraoperative, post-operative blood salvage.
|