[Transfusion and Jehovah's witnesses. A review of medicosurgical attitudes in a University hospital in 1995]

[Physicians' perception on taking care of Jehovah's witnesses]

PURPOSE OF THE STUDY

The goal of this study is to assess the physician's management of patients who refuse blood transfusion.

MATERIAL AND METHODS

A questionnaire to assess the experience, the acceptance or refusal and the operating methods in case of vital risk has been realized and circulated at a national scale.

RESULTS

A total of 793 questionnaires were sent back and analysed according to 3 different categories: anesthesiologists, physicians and surgeons. Seventy-nine percent of total respondents and 90% of anesthesiologists had had to take care of a Jehovah's Witness. In 51% of all cases, it appears to be associated with mainly relational problems with the patient or his family. Nevertheless, 83% accept to take care a Jehovah witness, the most reluctant of them being anesthesiologists. A written confirmation of blood transfusion refusal even at vital risk and a piece of written evidence of belonging to Jehovah's Witnesses are not systematically required. For them, the impossibility to foresee with certainty the need for blood transfusion represents the main barrier to the medical care of a Jehovah's Witness. In case of imminent vital risk and if there are no available alternative procedures, 67% of respondents administer blood products (89% if the patient is unconscious).

CONCLUSION

This situation has nothing exceptional but the medical community does not seem to know all the regulatory requirements. Generally speaking, they do not oppose the medical care of a Jehovah's Witness, but remain committed to their primary focus: to save the patient, as long as it is not an end-of-life situation.

[Hemorrhagic surgery in two Jehova's witness children refusing programmed autotransfusion: a place for erythropoietin]

We report two cases of haemorrhagic surgery in a 6-year-old and 16-year-old girl, respectively, whose parents were Jehovah's witnesses and therefore opposed to preoperative blood donation, but accepting intraoperative blood salvage. Erythropoietin and intravenous iron were administered preoperatively to increase red cell mass. Intraoperative blood salvage, including normovolaemic haemodilution and intraoperative autologous transfusion, avoided homologous blood transfusion.