Jehovah's Witnesses - How to Encounter the Transfusion Issue

Abstract

Surgical management is different for Jehovah's Witnesses than in customary operations. Preoperative measures primarily aim at an optimal hematological condition, whereas intraoperative activities are directed towards minimizing blood loss. However, physicians taking care of Jehovah's Witnesses are not only faced with the difficulties of adequate treatment, but also by psychological and legal issues. Since the German legal system does not offer clear-cut legislation with regard to the Jehovah's Witnesses transfusion issue, guidelines have been offered on how to encounter his issue.

Key words

Open heart surgery - Jehovah's Witness - blood transfusion - legislation

References

• 1 Lewis T P, Murphy M C, Cooley D A. Risk factors for cardiac operations in adult Jehovah's Witnesses.  Ann Thorac Surg. 1991;  51 448-450
• 2 Carmichael M J, Cooley D A, Kuykendall R C, Walker W E. Cardiac surgery in children of Jehovah's Witnesses.  Tex Heart Inst J. 1985;  12 57-63
• 3 McMullan D M, Beyer E AK, Gregoric I, Radovancevic B, Frazier O H. Left ventricular reduction in a Jehovah's Witness.  Ann Thorac Surg. 2000;  70 958-961
• 4 Spence R K, Alexander J B, Del Rossi A J. et al . Transfusion guidelines for cardiovascular surgery: lessons learned from operations in Jehovahs's Witnesses.  J Vasc Surg. 1992;  16 825-831
• 5 Levine E, Gould A, Rosen A. et al . Perioperative recombinant human erythropoietin.  Surgery. 1989;  106 432-437
• 6 Rohling R G, Zimmermann A P, Breymann C. Intravenous versus oral iron supplementation for preoperative stimulation of hemoglobin synthesis using recombinant human erythropoietin.  J Hematother Stem Cell Res. 2000;  9 497-500
• 7 Harker L A. Therapeutic cytokine stimulation of thrombocytopoiesis.  Transfus Sci. 1998;  19 149-162
• 8 Serke S. Hematopoietic growth factors as an adjunct for neutropenic patients in the ICU: still a controversial issue.  Intensive Care Med. 1999;  25 901-902
• 9 Rousou J, Levitsky S, Gonzalez-Lavin L. et al . Randomized clinical trial of fibrin sealant in patients undergoing resternotomy or reoperation after cardiac operations. A multicenter study.  J Thorac Cardiovasc Surg. 1989;  97 194-203
• 10 Rosolski T, Matthey T, Frick U, Hachenberg T. Blood separation with two different autotransfusion devices: effects on blood cell quality and coagulation variables.  Int J Artif Organs. 1998;  21 820-824
• 11 Royston D. High-dose aprotinin therapy: a review of the first five years' experience.  J Cardiothorac Vase Anesth. 1992;  6 76-100
• 12 Cosgrove D M, Heric B, Lytle B W. et al . Aprotinin therapy for reoperative myocardial revascularization: a placebo-controlled study.  Ann Thorac Surg. 1992;  54 1031-1038
• 13 Lemmer J H, Stanford W, Bonney S L. et al . Aprotinin for coronary bypass operations: efficacy, safety, and influence on early saphenous vein graft patency - a multicenter, randomized, double-blind, placebo-controlled study.  J Thorac Cardiovasc Surg. 1994;  107 543-553
• 14 Rosengart T K, Helm R E, Klemperer J, Krieger K H, Isom O W. Combined aprotinin and erythropoietin use for blood conservation: results in Jehovah's Witnesses.  Ann Thorac Surg. 1994;  58 1397-1403
• 15 Vander Salm T J, Ansell J E, Okike O N. et al . The role of epsilon-aminocaproic acid in reducing bleeding after cardiac operation: a double-blind randomized study.  J Thorac Cardiovasc Surg. 1998;  95 538-540
• 16 Horrow J C, Hlavacek J, Strong M D. et al . Prophylactic transexamic acid decreases bleeding after cardiac operations.  J Thorac Cardiovasc Surg. 1990;  99 70-74
• 17 Casati V, Guzzon D, Oppizzi M. et al . Hemostatic effects of aprotinin, tranexamic acid and e-aminocaproic acid in primary cardiac surgery.  Ann Thorac Surg. 1999;  68 2252-2257
• 18 Mannucci P M. Desmopressin (DDAVP).  Haemophlia. 2000;  6 (Suppl 1) 60-67
• 19 Levi M, Cromheecke M E, de Jonge E. et al . Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints.  Lancet. 1999;  354 1940-1947
• 20 Röttgers H R, Nedjat S. Kritik am Transfusionsverbot nimmt zu.  Dtsch Ärtzebl. 2002;  99 A 102-105