Surgical management in treatment of Jehovah′s witness in trauma surgery in Indian subcontinent

Nishant,; Kumari, Renu

doi:10.4103/0974-2700.136868

Cited by 10 publications

(7 citation statements)

References 54 publications

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“…Intraoperative cell salvage is a safe and cost-effective alternative to blood transfusion, reducing the need for transfusion across a variety of surgical specialties. 16,39,71,72 Guidelines recommend cell salvage when expected operative blood loss is greater than 500 mL, the amount required for a clinically relevant amount of blood to be reinfused. 73 This technique involves collecting blood that is lost during surgery or through wound drains and reinfusing it after centrifugation, washing, and anticoagulation.…”

Section: Intraoperative Strategiesmentioning

confidence: 99%

Pediatric and Adolescent Jehovah's Witnesses: Considerations for Safe and Ethical Orthopaedic Procedures

Wong¹,

Mistovich²,

Morrison³

2022

Journal of the Pediatric Orthopaedic Society of North America

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Jehovah’s Witnesses are members of a restorationist Christian denomination. Among their beliefs, most important for consideration of the pediatric orthopaedic surgeon, is their refusal of blood transfusions, particularly in consideration of the small range of acceptable blood loss in young children and high-risk cases such as spine and pelvic surgery. Thus, we examined the legal, ethical, and medical issues surrounding treatment of Jehovah’s Witnesses in order to have collaborative conversations towards the best possible care and avoidance of harm. We have found that while previous case rulings have been quite clear in outlining the treatment of young children of Jehovah’s Witnesses, there is much more variability in the treatment of those who are adolescents and who have capacity to consent. Therefore, care must be taken in maintaining frequent communication with pediatric patients’ families and assessing the acceptable treatment for the patient. Preoperatively, planning requires multi-disciplinary coordination, verification of acceptable blood products, and anemia optimization. Furthermore, by utilizing various intraoperative and postoperative techniques, bloodless surgery can be successfully performed with similar outcomes as other patient groups.

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Section: Intraoperative Strategiesmentioning

confidence: 99%

Pediatric and Adolescent Jehovah's Witnesses: Considerations for Safe and Ethical Orthopaedic Procedures

Wong¹,

Mistovich²,

Morrison³

2022

Journal of the Pediatric Orthopaedic Society of North America

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“…In that respect, the use of TXA makes sense mechanistically. Nonallogeneic pharmacological interventions should be discussed and decided upon on a case-by-case basis using shared decision making and may include antifibrinolysis, erythropoiesis, and stimulating blood factor production, in addition to maintaining adequate organ perfusion, controlling blood loss, and maximizing hemostasis (Nishant & Kumari, 2014; Zeybek et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid for the Treatment of Acute Gastrointestinal Bleeding in a Jehovah's Witness Patient on Apixaban and Dual Antiplatelet Therapy

Yurukov

Boykin

Rech

2022

Advanced Emergency Nursing Journal

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Life-threatening bleeding can be challenging to manage, especially in patients who reject allogeneic transfusions for religious or personal reasons. Tranexamic acid (TXA) has been successfully used to treat acute bleeding in multiple settings with varying severity, including trauma, women with postpartum hemorrhage, hemoptysis, and epistaxis, with minimal adverse effects. The purpose of this case report is to describe the use of TXA to aid in achieving hemostasis in a Jehovah's Witness patient on apixaban with a life-threatening gastrointestinal (GI) bleed. An 80-year-old female Jehovah's Witness patient on apixaban for lower extremity deep vein thrombosis presented to the emergency department with 8 hr of GI bleeding. On presentation, she was hemodynamically unstable, requiring a norepinephrine infusion. She refused any blood-derived products or anticoagulant reversal agents derived from human or animal products. One 1-g dose of intravenous TXA was given as a bolus for more than 10 min, followed by another 1-g dose for more than 8 hr. The patient achieved successful hemostasis allowing for further inpatient management and eventually was discharged from the hospital. This case describes a life-threatening GI bleed in a Jehovah's Witness patient who was successfully treated using TXA.

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“…This requires a multidisciplinary approach involving the patient, their family, and the healthcare team to arrive at a shared decision-making process that considers the patient’s health, religious beliefs, and cultural background. 3 In this essay, we will explore the challenges and opportunities presented by caring for Jehovah’s Witness patients undergoing major urgent abdominal surgeries with life- threatening anemia in middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

Major abdominal surgery for Jehovah’s Witnesses: Challenge while practicing bloodless medicine in a middle income country

Gavrilovska-Brzanov,

Gjambaz,

Naumovski

et al. 2023

SAGE Open Medical Case Reports

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We present a 59-year-old female Jehovah’s Witness patient transferred from another facility to our tertiary center as an emergency case owing to anemia due to gastrointestinal bleeding. A computed tomography scan and gastroscopy confirmed an invasion of the duodenum by a malignant process. The patient underwent a Whipple procedure and a right hemicolectomy refusing blood transfusion. On the 17th postoperative day, the patient was discharged following a successful surgery. This article’s objectives are to first highlight the moral and ethical quandary and then share our surgical experiences with this particular patient population. In conclusion, Jehovah’s Witnesses’ management of major abdominal surgery poses considerable clinical, moral, and legal difficulties. Despite them, doctors must put the patients’ needs first while also honoring their religious convictions. However, urgent situations continue to arise, forcing medical professionals to weigh their religious convictions against the need to save a patient’s life.

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Surgical management in treatment of Jehovah′s witness in trauma surgery in Indian subcontinent

Cited by 10 publications

References 54 publications

Pediatric and Adolescent Jehovah's Witnesses: Considerations for Safe and Ethical Orthopaedic Procedures

Pediatric and Adolescent Jehovah's Witnesses: Considerations for Safe and Ethical Orthopaedic Procedures

Tranexamic Acid for the Treatment of Acute Gastrointestinal Bleeding in a Jehovah's Witness Patient on Apixaban and Dual Antiplatelet Therapy

Major abdominal surgery for Jehovah’s Witnesses: Challenge while practicing bloodless medicine in a middle income country

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