The perioperative management of Jehovah’s Witnesses can be a focus of great concern, with strongly divergent opinions. Some of these are addressed here.
It is always useful to consider that ‘normal’ clinical practices presume that a patient can (if necessary) be transfused. Thus in the patient that cannot be transfused, ‘normal’ practice must change. This means different preparation; ‘aggressive’ avoidance of blood spillage; meticulous haemostasis; minimising blood loss by testing procedures, and changed post-operative observations with a raised awareness of the need to detect and intervene early if there is ongoing haemorrhage.
Guidelines
- Preoperative Consultations with Jehovah’s Witnesses
- Management of Adult Jehovah’s Witnessess in Anaesthesia
Background/References
The following two documents are sourced from Victoria and are of interest. Note that the policy from the Austin hospital suggests involving the ‘Hospital Liaison Committee’ directly. This is not necessarily appropriate. It is up to the patient, and the patient alone, if they wish other people to know about their medical issues and if they should be involved. It is entirely possible that the patient may specifically NOT want someone from their faith organisation (nor members of their family, or friends) to be informed.
A general practical overview from the BMJ in 2013. Some would disagree with some aspects of this paper – particularly the suggestion to proactively involve others – but it provides useful ‘short’ and long’ answers to common questions.
Lawson T Perioperative re J-W-1
1: Lawson T, Ralph C. Perioperative Jehovah's Witnesses: a review. Br J Anaesth. 2015 Nov;115(5):676-87. doi: 10.1093/bja/aev161. Epub 2015 Jun 11. Review. PubMed PMID: 26068896.
Discussion Notes
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