Optimizing Outcomes in the Jehovah’s Witness Following Trauma: Special Management Concerns for a Unique Population

Georgiou, Chrysanthos; Inaba, Kenji; DuBose, Joseph J.; Teixeira, Pedro G.R.; Hadjizacharia, Pantelis; Salim, Ali; Brown, Carlos; Rhee, Peter; Δημητριάδης, Δημήτριος

doi:10.1007/s00068-009-8246-6

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…These nutrients are important adjuncts in hemoglobin production and enhance the hemoglobin response to erythropoietin [ 20 ]. In one study, iron supplementation was shown to be beneficial and was strongly considered an adjunct in managing Jehovah’s Witness patients [ 21 ]. In the present case, the patient was administered ferrous sulfate, folic acid, iron isomaltoside, and vitamin B12 supplementation.…”

Section: Discussionmentioning

confidence: 99%

“…In connection with this, careful observation should be performed in patients with coagulopathy and who are on mechanical ventilation. One study showed that the risk of gastric ulcer bleeding increased in this patient group [ 21 ]. Approximately 25% of ICU patients who do not receive prophylactic measures experience gastrointestinal bleeding due to gastric ulcers [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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Successfully Managing Severe Anemia in a Trauma Patient Who Refused Blood Transfusion: A Case Report

Sanchez,

Lee,

Lee

2023

Am J Case Rep

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Patient: Male, 71-year-old Final Diagnosis: Traumatic hemothorax with multiple rib fractures (1 st , 2 nd , 7 th –12 th right ribs; 1 st –9 th , 11 th left ribs), compression fracture of thoracic vertebrae (T10), closed Left iliac pelvic bone fracture and pneumomediastinum Symptoms: Bleeding • dyspnea • severe anemia Clinical Procedure: Abdomen CT • arterial line catherization • central venous catheterization • chest CT scan • chest tube • chest xray • endoscopy • tracheostomy Specialty: Critical Care Medicine • Surgery Objective: Management of emergency care Background: Surgical management in patients who undergo traumatic blood loss but who refuse blood transfusion can be challenging, but physicians and surgeons must comply with the wishes and beliefs of their patients. This report describes the management of severe anemia, with hemoglobin level of 2.5 g/dL, in a 71-year-old male Korean trauma patient who declined blood transfusion. Case Report: A 71-year-old man was admitted to hospital with severe blood loss following trauma. He declined blood transfusion due to his religious belief as a Jehovah’s Witness. On day 4, the patient’s hemoglobin level dropped from 7.7 to 3.9 g/dL. Despite the need for blood transfusion, the patient refused. Hence, therapeutic strategies, including crystalloid fluid resuscitation, bleeding control, vasopressor support, erythropoietin administration, supplementation with iron, folic acid, and vitamin B12, coagulopathy correction, oxygen consumption reduction, and mechanical ventilation were implemented. Following 16 days of supportive management, the hemoglobin reached 7.4 g/dL. However, it suddenly decreased on day 41 (2.5 g/dL) due to episodes of melena secondary to an actively bleeding gastric ulcer, which was successfully managed with endoscopic hemostasis. Despite increased vasopressor dosage and addition of vasopressin and hydrocortisone, the patient became unresponsive with persistent hypotension. Methylene blue was used as the final therapeutic agent. The patient responded well and subsequently recovered without blood transfusion. Conclusions: This report has presented the clinical challenges of managing the case of a patient who requires but declines blood transfusion and has highlighted the approach to clinical care while respecting the wishes of the patient.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successfully Managing Severe Anemia in a Trauma Patient Who Refused Blood Transfusion: A Case Report

Sanchez,

Lee,

Lee

2023

Am J Case Rep

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Treatment of individuals who cannot receive blood products for religious or other reasons

et al. 2017

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By virtue of their religious principles, Jehovah's Witnesses (JWs) generally object to receiving blood products, raising numerous ethical, legal, and medical challenges for providers who care for these patients, especially in the emergent setting. In this review, we discuss several areas relevant to the care of JWs, including the current literature on "bloodless" medical care in the setting of perioperative and intraoperative management, acute blood loss, trauma, pregnancy, and malignancy. We have found that medical and administrative efforts in the form of bloodless medicine and surgery programs can be instrumental in helping to reduce risks of morbidity and mortality in these patients. Planning prior to an anticipated event associated with blood loss or anemia (such as elective surgery, pregnancy, and chemotherapy) is critical. Specifically, bloodless medicine programs should prioritize vigilant early screening and management of anemias, early establishment of patient wishes regarding transfusion, and the incorporation of those wishes into multidisciplinary medical and surgical care. Although there are now a variety of human-based and nonhuman-based products available as transfusion alternatives, the degree and quality of evidence to support their use varies significantly between products and is also largely dependent on the clinical setting.

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Trauma e transfusão sanguínea precoce: o desafiante manejo de hemorragias em Testemunhas de Jeová.

Lima

Byk

2018

Rev. Col. Bras. Cir.

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RESUMO O manejo de pacientes que se recusam a receber transfusões de sangue e de seus produtos, como as Testemunhas de Jeová, apresenta-se frequentemente como desafio médico, não só pelo dilema ético, mas porque cria um importante obstáculo ao rápido controle de hemorragias num cenário de trauma. Este artigo explora as razões deste conflito entre o dever de cuidado do médico e o respeito à autonomia do paciente, e desenha um panorama dos entendimentos majoritários do Judiciário sobre o tema. Por fim, conclui-se que a manifestação de vontade do paciente, embora livre, não é suficiente para afastar o médico do seu dever de cuidado. Constatando perigo à vida, o médico deverá proceder a transfusão de sangue, independentemente de consentimento do paciente ou de seus responsáveis.

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Optimizing Outcomes in the Jehovah’s Witness Following Trauma: Special Management Concerns for a Unique Population

Cited by 3 publications

References 13 publications

Successfully Managing Severe Anemia in a Trauma Patient Who Refused Blood Transfusion: A Case Report

Successfully Managing Severe Anemia in a Trauma Patient Who Refused Blood Transfusion: A Case Report

Treatment of individuals who cannot receive blood products for religious or other reasons

Trauma e transfusão sanguínea precoce: o desafiante manejo de hemorragias em Testemunhas de Jeová.

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