Jehovah's Witnesses and perioperative blood management strategies
Anne (Afia) Owusu, BSN, RN; Lauren Barnes, DNP, CRNA
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Traditionally, total hip replacement surgery involves moderate to significant bleeding, which poses a particular risk for Jehovah's Witness patients. Jehovah's Witness is a religious organization consisting of approximately 8.5 million members worldwide, of whom 1.3 million reside in the United States of America. It prohibits its members from receiving allogeneic blood products, which present ethical, legal, and medical challenges during surgeries. Members can be expelled for willfully receiving blood. Studies indicated that Jehovah's Witness surgical patients have comparable outcomes to those who received blood products. The purpose of this study is to review blood conservation strategies to optimize the care of patients who undergo bloodless surgeries. Although Jehovah's Witnesses grossly refuse whole blood and its primary products, individuals may be able to receive blood derivatives (cryoprecipitate, fibrinogen concentrate, fibrin glue, platelet gel, and albumin). Also, acceptable procedures and therapies are normovolemic hemodilution, cell salvage, hemodialysis or continuous renal replacement therapy, extracorporeal membrane oxygenation, and cardiopulmonary bypass. Autologous blood stored for a few weeks before surgery is unacceptable. The literature revealed that patients had better outcomes when blood conservation strategies were implemented at each step in the perioperative period—pre-, intra-, and post-operative. A senior hematologist, anesthetist, and surgeon made clinical decisions. Pre-operative evaluation of patients who refuse blood transfusion should be at least 6 weeks before surgery. Hemoglobin levels of less than 10g/dL should be considered for oral/IV iron and erythropoietin. Intraoperative management should include the World Health Organization surgical checklist emphasizing the patient's blood status and allowing all team members to be unanimous. Intraoperative blood management includes acute normovolemic hemodilution, pharmacological modalities, and anesthesia strategies. Coagulopathy may be prevented by keeping the patient warm. Literature suggests post-operative management should include a thorough handoff, using pediatric blood sampling tubes, and avoiding unnecessary blood draws.
|DNP Capstone Project
|None: Degree-based Submission
Patient Beliefs Related to Healthcare;
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