Guidelines on transfusion of red blood cells: Prognosis of patients who decline blood transfusions

Langhi, Dante Mário; Covas, Dimas Tadeu; Marques, José Francisco Comenalli; Mendrone, Alfredo; Ubiali, Eugênia Maria Amorim; Santis, Gil Cunha De; Kelmann, Gizela; Bernardo, Wanderley Marques

doi:10.1016/j.htct.2018.08.001

Cited by 8 publications

(10 citation statements)

References 18 publications

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“…A extração e a análise dos dados permitiram a identificação de três categorias temáticas: Estratégias alternativas ao uso de hemocomponentes; Abordagem bioética na recusa do paciente Testemunha de Jeová e Abordagem jurídica na recusa do paciente Testemunha de Jeová. Os estudos flutuavam suas discussões por mais de uma abordagem, com síntese apresentada nas Categoria 1: Estratégias alternativas ao uso de hemocomponentes Usar transportadores de oxigênio à base de hemoglobina 15,17,26 Administrar concentrado de fibrinogênio 17,19 Fazer uso de expansores de volume sem sangue (cristaloides e coloides) 19,22,24,31 Usar agentes sistêmicos para melhorar a hemostasia e a atividade dos fatores de coagulação: sulfato de protamina, vitamina K, complexos de protrombina, aprotinina, ácido aminocaproico e tranexâmico; fator VII; fator concentrado de complexo de protrombina; crioprecipitado, desmopressina, estrogênios conjugados; fatores de coagulação sem albumina; agentes hemostáticos tópicos, gluconato de cálcio, de magnésio; eritropoetina, ferro, ácido fólico, vitamina C e B12 [15][16][17]19,[22][23][24]26,27,30,31,33 Fazer uma boa anamnese (reconhecer fatores de risco de sangramento ou anemia pode ajudar os clínicos a prever/perceber a necessidade de medidas preventivas ou de controle) 20,24,25,30,31 Evitar exames de sangue desnecessários 15,23,24,26,27,31 Usar frasco de coleta de sangue pediátrico 15,23,[25][26][27]...…”

Section: Resultsunclassified

Transfusão de sangue e hemocomponentes para as Testemunhas de Jeová: revisão de escopo

et al. 2022

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Objetivo: mapear os estudos que abordam a não transfusão de sangue e hemocomponentes ao paciente Testemunha de Jeová. Método: revisão de escopo, seguindo o método proposto pelo Instituto Joanna Briggs. Foram realizadas buscas em doze bases de dados nacionais e internacionais, em outubro de 2020. Não foi utilizado recorte temporal. Resultados: dos 1435 artigos encontrados nas bases de dados pesquisadas, 21 foram incluídos neste estudo, seus conteúdos foram sintetizados em três categorias: 1) Estratégias alternativas ao uso de hemocomponentes; 2) Abordagem jurídica na recusa do paciente Testemunha de Jeová; 3) Abordagem bioética na recusa do paciente Testemunha de Jeová. Conclusão: a presente revisão de escopo permitiu mapear a literatura e conhecer as inquietações e as estratégias usadas na assistência ao paciente TJ que por questões religiosas recusa transfusão de sangue e hemocomponentes. A compreensão dessas alternativas será fundamental para a garantia de uma assistência segura e na preservação da autonomia do indivíduo.

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Section: Resultsunclassified

Transfusão de sangue e hemocomponentes para as Testemunhas de Jeová: revisão de escopo

et al. 2022

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“…Both methods were applied in our patient. Guidelines also advise compensating any hematinic deficiencies with erythropoiesis-stimulating agents, iron, folic acid and vitamin B12 [3]. In our case, we used epoetin alfa intravenously as oppose to subcutaneous route, as it allows faster patient response and greater flexibility in terms of dosing [4].…”

Section: Discussionmentioning

confidence: 99%

Let us use physiologic transfusion triggers: Favorable outcome in an 86-year-old Jehovah's witness with a haemoglobin nadir of 44g L-1

Czempik

Wojnarowicz

Krzych

2020

Transfusion and Apheresis Science

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The number of Jehovah's Witnesses worldwide is estimated at approximately 8.6 million. As Jehovah's Witnesses refuse administration of blood and blood-derived products on religious grounds, transfusion of red blood cells is not an option. It is especially problematic when anaemia develops acutely, as in non-elective surgery, as there is no time to optimise volume of red blood cells preoperatively. We present a case of an 86-year-old woman who underwent non-elective laparoscopic cholecystectomy due to gangrenous cholecystitis. Post-operatively the patient was hospitalised in an intensive care unit where the haemoglobin concentration reached nadir of 44 g L-1. Despite developing severe anaemia, the patient survived and did not suffer from long-term sequelae. To our knowledge, the patient presented here was the oldest patient who survived anaemia of such severity to date. When deciding on red blood cells transfusion clinicians should consider patient's physiologic response to anaemia, as tolerance of anaemia is variable among patients. Even elderly patients may tolerate severe anaemia, as it has been shown in our care report.

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“…With the application of these proactive approaches, the patient may not reach a restrictive transfusion threshold, minimising or eliminating the administration of blood products. Even when it is not possible to act prior to surgery, strategies for the management of postoperative anaemia after major surgery remain applicable, [17] and the literature has many examples of complex interventions performed without using blood transfusion, with results that are similar, if not better, than those of transfused patients [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Patient blood management is not a specific medical intervention or an alternative to allogeneic blood transfusion; it is sound evidence-based clinical practice.…”

Section: Patient Blood Management: a Solution To Manage The Patient's Blood With Better Outcomesmentioning

confidence: 99%

Physician autonomy and patient rights: lessons from an enforced blood transfusion and the role of patient blood management

et al. 2021

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This article provides an ethical and medico-legal analysis of ruling no. 465 of 30 May 2018 issued by the Court of Termini Imerese (Palermo) and confirmed on appeal on 11 November 2020, which, in the absence of similar historical precedents in Europe, convicted a medical doctor of a crime of violent assault for having ordered the administration of a blood transfusion to a patient specifically declining blood transfusion on religious grounds. We analyse the Court's decision regarding the identification of assault in performing the blood transfusion and its decision not to accept exculpatory urgent 'necessity' as a defence. In addition, we present an updated revision of the current standard of care in transfusion medicine as well as the ethical principles governing the patient's declining of transfusion. In doing so, we highlight that respect for the patient's self-determination in declining transfusions and respect for the professional autonomy of the doctor protecting the safety and life of the patient could be equally satisfied by applying the current peer-reviewed evidence.

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Guidelines on transfusion of red blood cells: Prognosis of patients who decline blood transfusions

Cited by 8 publications

References 18 publications

Transfusão de sangue e hemocomponentes para as Testemunhas de Jeová: revisão de escopo

Transfusão de sangue e hemocomponentes para as Testemunhas de Jeová: revisão de escopo

Let us use physiologic transfusion triggers: Favorable outcome in an 86-year-old Jehovah's witness with a haemoglobin nadir of 44g L-1

Physician autonomy and patient rights: lessons from an enforced blood transfusion and the role of patient blood management

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