Conservative Blood Management in a Jehovah's Witness with Placenta Percreta: A Case Report and Transfusion Trigger Questioning

Abstract

Background: Jehovah`s witness is a Christian religion with 8.6 million worldwide members who recognize the Bible as God`s message to humanity. Based on their interpretation of the Bible, blood is seen as holy and sacred and therefore blood component transfusions are not allowed. This is a special concern in cases of severe anemia and non-elective surgeries as there is no time to restore blood storages and reduce the risk of exogenous blood need. Case Report: Here we present the case of a 33-year-old Jehovah`s Witness with an infected miscarriage and placenta percreta confirmed during operation. A nadir of 5.1 g/dL hemoglobin was reached but, despite severe anemia, no hemodynamic instability or increased lactate levels were noticed and no blood components administrated. Conclusion: As blood transfusion carries in itself potential risks and is a special issue in this group of patients this report suggests that blood transfusions should be guided by personal triggers, based on hemodynamic and laboratorial levels associated with age and co-morbidities.