Jehovah's Witness Patients
A trauma patient who refuses blood products requires special management.
Early identification and control of hemorrhage are obviously important, as for any
trauma patient; deliberate hypotension to limit bleeding is even more appropriate.
Preoperative and intraoperative phlebotomy
should be minimized, possibly by using pediatric blood collection tubes. The use
of salvaged red cells (from intraoperative collection or from a chest drainage system)
should be discussed with the patient; some Jehovah's Witness patients will allow
the use of salvaged blood provided that the entire system remains in continuity with
the vasculature.[216]
Early hemodynamic monitoring
is indicated to help determine the role of colloid therapy, pressors, and inotropes
in maintaining tissue oxygen delivery at the highest possible level. Case reports
have described the successful use of rFVIIa and HBOCs in Jehovah's Witness patients
to rapidly correct bleeding and support oxygen delivery, but these agents are not
licensed for these uses and may be difficult to obtain when needed.[217]
Postoperatively, the use of erythropoietin to promote red cell growth will shorten
the period of relative anemia.[218]
