Haematological care of the jehovah's witness patient*

Marsh, Judith; Bevan, David

doi:10.1046/j.1365-2141.2002.03639.x

Cited by 56 publications

(43 citation statements)

References 66 publications

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“…Recombinant Human Erythropoietin (RHE) is one of many supportive measures -including Cell saver, coagulating instruments, volume expanders and controlled hypotension -that can support bloodless surgery in high risk procedures [1]. RHE bolsters bone marrow production of erythrocytes, and can be given in the pre-or postoperative setting [35,36]. There are no prospective, randomized trials to determine appropriate dosing, but case reports have recorded success with ranges as wide as 60-500 Units/kg given subcutaneously either daily or several times per week.…”

Section: Discussionmentioning

confidence: 99%

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Eun¹

2015

JURNOA

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Research ArticleAnother group in which BT utilization is limited is the Jehovah's Witness (JW) population. The JW religion is a Christianbased faith founded in the United States characterized by the avoidance of BT, even if it may lead to morbidity or mortality [10]. Because of this belief, many JW patients may experience difficulty in finding surgeons willing to perform elective major operations.Partial Nephrectomy (PN) has been recognized as the standard of care operation for the small renal mass (< 4cm) [11]. While PN has been heralded as a nephron-sparing surgical approach, the incidence of post-operative complications -including hemorrhage and pseudoaneurysm -may prevent widespread adoption [12]. One potential advantage of Robotic Partial Nephrectomy (RPN) is that it may mitigate the hemorrhagic complications and thus make this operation more accessible [13]. This could have particular applications in the JW population.We present the first published series of RPN in a group of JW patients. MethodsAfter proper internal review board approval, we prospectively maintained a database of JW patients undergoing RPN between 2010-2014. The procedures were performed by a single surgeon at two institutions. Preoperative optimization with a hematologist was sought on every procedure, as a part of the Bloodless Medicine program at our institution.All procedures were performed in a transperitoneal fashion. Intraoperative ultrasound was used to localize the tumor, and artery-only clamping was performed unless venous backbleeding was encountered. Tumor excision was performed using a standard technique, with cold scissors and gentle retraction.Renorrhaphy was performed using our innovation of the sliding-clip technique [14], which is unique to our institution. The suture consists of two V-LOC (Medtronic, Minneapolis, MN) sutures attached at the tails Figure 1. The first layer of closure is performed using the 3-0 V-LOC with a CV-23 needle, which is similar to a RV-1. Critical to this step is the approximation of the corticomedullary junction, as this tends to be the stronger layer. Also important in this step is the closure of any collecting Abstract Background: Recent interest in "bloodless" surgery places the urologic surgeon in a difficult position, especially as surgeries such as partial nephrectomy with an increased risk of bleeding, grow in popularity and the availability of blood for transfusion decreases. Jehovah's Witnesses are a religious group that refuses blood transfusion on religious grounds, which necessitates surgery in a setting where blood transfusion is not an option.

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Section: Discussionmentioning

confidence: 99%

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Eun¹

2015

JURNOA

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“…Jehova's witnesses (JWs), necessitate a tailored strategy warranting the optimal surgical management, in observance to their religion principles [2].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous coronary artery bypass grafting and carotid endarterectomy in an awake Jehova's witness patient without endotracheal intubation

Gerosa

Grego

Falasco

et al. 2005

European Journal of Cardio-Thoracic Surgery

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Complex surgical procedures are associated with a major risk of peri-operative bleeding. Jehova's witnesses (JW) necessitate a tailored strategy warranting the optimal surgical management, in observance to their religion principles. In this report, we present a JW female patient, who underwent combined coronary artery bypass grafting and carotid endarterectomy, with neither endotracheal intubation nor general anaesthesia. Patient had previously undergone bilateral endarterectomy and required a reoperation on the left side. She was also scheduled for revascularization of left anterior descending coronary artery. After an extensive evaluation of all the possible operative strategies, we planned to perform CABG via a mid-line sternotomy, followed by CEA, in the awake patient. There were no intra-operative complications. Hb level, monitored by blood gases controls, maintained above 10 g/dl. The post-operative course was uneventful. In this patient, for the first time, a high-risk CABG procedure and a high-risk CEA were carried out simultaneously, in the awake setting. This approach represented a meeting point between surgical requirements and specific patient's needs. We believe it could be a safe alternative management applicable to high risk candidates to combined carotid and coronary artery surgery, presenting with bleeding-related issues.

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“…Jehovah's Witnesses are well known in the medical world for their refusal on the acceptance of blood and blood products [1]. Unique aspects of these beliefs can pose health care providers with challenging medical, legal and ethical dilemmas.…”

Section: Introductionmentioning

confidence: 99%

Major surgery in an osteosarcoma patient refusing blood transfusion: case report

et al. 2010

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We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.

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Haematological care of the jehovah's witness patient*

Cited by 56 publications

References 66 publications

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Simultaneous coronary artery bypass grafting and carotid endarterectomy in an awake Jehova's witness patient without endotracheal intubation

Major surgery in an osteosarcoma patient refusing blood transfusion: case report

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