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Nri-Ezedi CA, Ulasi T, Efobi CC, Aneke JC, Ugwu N, Nwosu C. Bloodless management of significantly elevated transcranial Doppler velocity value in a Jehovah's witness child with sickle cell disease: A tertiary centre experience-A case report. J Natl Med Assoc 2024:S0027-9684(24)00020-8. [PMID: 38310045 DOI: 10.1016/j.jnma.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Effective management of complications in sickle cell disease (SCD), such as stroke prevention, often necessitates the use of blood transfusions. However, individuals who adhere to the religious tenets of Jehovah's Witnesses strictly abstain from accepting blood transfusions, thereby presenting a formidable challenge in clinical decision-making. CASE REPORT This is a case of a 3 year old child Jehovah's Witness who was found to have significantly elevated transcranial Doppler (TCD) velocity values between 193 and 203 cm/s, following routine screening. This was an otherwise clinically stable child, whose mother was diligently ensuring he had adequate medical care. Ideally, a prophylactic exchange blood transfusion program would have been commenced immediately but was not done due to due to the lack of consent from the caregiver. Patient was initially on hydroxyurea at 15 mg/kg and self medicating on omega 3 supplements and astymin syrup. Further elevation of TCD velocity upto 242 cm/s after a repeat testing, necessitated graduated increase of the dosage of hydroxyurea to 35 mg/kg to optimize its therapeutic effect, and discontinuation of omega 3 fatty acids and replacement of astymin with folic acid, vitamin C and B complex. Following these adjustments, the TCD dropped to below 190 cm/s reducing the risk of stroke in the child. CONCLUSION This case report demonstrates the successful implementation of a bloodless management strategy for stroke prevention in a Jehovah's Witness child with SCD. This study contributes to the existing literature by providing valuable insights and practical guidance for healthcare providers facing similar ethical and medical dilemmas.
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Affiliation(s)
- Chisom Adaobi Nri-Ezedi
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Thomas Ulasi
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Chilota Chibuife Efobi
- Department of Haematology and Blood Transfusion, Faculty of Basic Clinical Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria.
| | - John Chinawaeze Aneke
- Department of Haematology and Blood Transfusion, Faculty of Basic Clinical Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Nwanneka Ugwu
- Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Chinekwu Nwosu
- Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus. Anambra State, Nigeria
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2
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Amorim Filho FS, Gripp FM, Faria GS, Capuzzo Gonçalves M, Miyahira L. Hemangiopericytoma: Conducts and perioperative management of an extent sinonasal tumor in a Jehovah's Witnesses patient - Case report. Cancer Rep (Hoboken) 2022; 5:e1609. [PMID: 35194976 PMCID: PMC9458489 DOI: 10.1002/cnr2.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/02/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hemangiopericytomas (HPCs) are rare tumors derived from mesenchymal cells with pericyte differentiation. About 5% of head and neck HPCs occur in the nasal cavity and paranasal sinuses. Due to its rarity, rich vascularity and variable biological behavior, its management is a challenge in itself. Case We report a case of sinonasal HPC in a Jehovah's Witness patient and discuss the obstacles and care related to the restrictions and therapeutic challenges involved in the approach to the patient. The patient was successfully treated by endoscopic endonasal approach with all per‐operative care and restrictions being respected and attended. Conclusions The management of HPC by itself involves challenges and when associated with other restrictive conditions attention and care are required.
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Affiliation(s)
- Francisco S Amorim Filho
- Head and Neck Surgery and Otorhinolaryngology Service, Instituto da Tireoide e Laringe, Goiânia, Brazil.,Department of Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas de Goiânia (HC-UFG), Goiânia, Brazil
| | - Flávio M Gripp
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas (UNICAMP), Campinas, Brazil
| | - Guilherme S Faria
- Head and Neck Surgery and Otorhinolaryngology Service, Instituto da Tireoide e Laringe, Goiânia, Brazil
| | - Mateus Capuzzo Gonçalves
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas de Goiânia (HC-UFG), Goiânia, Brazil
| | - Lincoln Miyahira
- Head and Neck Surgery and Otorhinolaryngology Service, Instituto da Tireoide e Laringe, Goiânia, Brazil
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3
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Eom KS. Surgical Experience of Posterior Fossa Meningioma in a Jehovah's Witnesses Patient. Brain Tumor Res Treat 2021; 9:26-30. [PMID: 33913269 PMCID: PMC8082283 DOI: 10.14791/btrt.2021.9.e4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/09/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022] Open
Abstract
Unexpected bleeding is a common complication that can occur during surgery. This unexpected bleeding can be managed by checking the patients' preoperative hemodynamic state or by autologous transfusion of an appropriate volume during surgery depending on the amount of blood loss and hemodynamic condition. However, patients like Jehovah's Witnesses, who refuse autologous transfusions for religious reasons even in life-threatening situations, present a predicament for treating physicians. The author reports on a large meningioma on the posterior fossa of a Jehovah's Witness patient who underwent surgery without autologous blood transfusion. There were no major problems other than the fear of unexpected massive bleeding. The surgeon's attention and efforts to minimize bleeding during surgery seemed to be the most important factors for success.
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Affiliation(s)
- Ki Seong Eom
- Department of Neurosurgery, Wonkwang University School of Medicine, Iksan, Korea.
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4
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Tse A, Chow O, Matar A, Alzahrani N, Morris D. Strategies for 'bloodless' surgery: the experience of cytoreductive surgery for peritoneal carcinomatosis in Jehovah's Witnesses. ANZ J Surg 2020; 90:1953-1957. [PMID: 32594642 DOI: 10.1111/ans.16101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/10/2020] [Accepted: 05/22/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) for the management of peritoneal carcinomatosis (PC) can involve significant blood loss which necessitates the transfusion of blood products. This poses a particular challenge in the Jehovah's Witnesses population whose beliefs do not permit the transfusion of blood products or blood-related derivatives. This report describes the experience of one institution performing CRS with hyperthermic intraperitoneal chemotherapy (HIPEC) for PC in Jehovah's Witnesses and perioperative management strategies employed to avoid blood transfusion. METHODS A review of literature and prospectively collated data of Jehovah's Witnesses patients who underwent extensive CRS for PC and HIPEC for PC. RESULTS Four patients had CRS and HIPEC for PC. The median PC index score was 11 and complete cytoreduction was achieved in all cases. Primary tumours were ovarian (n = 1), colorectal (n = 2) and neuroendocrine tumour of gastrointestinal origin (n = 1). The median difference between preoperative and postoperative haemoglobin was 38 g/L (23-43 g/L). Strategies included acute normovolumaeic haemodilution and autotransfusion within a closed circuit, autotransfusion from cell salvage and provisions for possible use of a haemoglobin based oxygen carrier. Ancillary measures identified and implemented to minimize transfusion dependence included, but were not limited to, preoperative iron infusion, perioperative acute haemodilution and cell salvage, administration of tranexamic acid, prothrombinex and use of paediatric tubes for venepuncture. CONCLUSION The review suggests CRS and HIPEC for extensive PC can be done safely in circumstances where transfusion of allogenic blood products is not permitted.
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Affiliation(s)
- Andrew Tse
- St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, St George Public Hospital, Sydney, New South Wales, Australia
| | - Oliver Chow
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Amer Matar
- Department of Surgery, St George Public Hospital, Sydney, New South Wales, Australia
| | - Nayef Alzahrani
- Department of Surgery, St George Public Hospital, Sydney, New South Wales, Australia
| | - David Morris
- St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, St George Public Hospital, Sydney, New South Wales, Australia
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Chang Lee R, Sukumaran S, Koczwara B, Woodman R, Kichenadasse G, Roy A, Vatandoust S, Karapetis C. Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma. Cancer Rep (Hoboken) 2019; 2:e1148. [PMID: 32721085 DOI: 10.1002/cnr2.1148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Supportive care of Jehovah's Witnesses (JWs) diagnosed with cancer can be challenging, as they do not accept red blood cell (RBC) transfusions. AIM The study was designed to determine treatment preferences and pattern of care offered to JWs diagnosed with cancer and its impact on cancer management. METHODS AND RESULTS A retrospective cohort study of JWs with solid malignancies or lymphoma in our institution between 2005 and 2015 was conducted. Survival statistics were estimated using Kaplan Meier survival curves and Cox proportional regression model. A total of 63 JWs were identified with a median age of 70 years. At diagnosis, 34% (n = 22) had anaemia. All 63 declined RBC transfusion, including 19 patients who later developed transfusion threshold during anti-cancer treatment. Forty-three percent (n = 27) JWs had advanced (stage 4) disease, and 76% (n = 48) had Eastern Cooperative Oncology Group of 0 to 1. JWs were willing to accept surgery and radiation rather than chemotherapy. Treatment was deemed to be suboptimal in 22% (n = 14) JWs due to early treatment discontinuation, administration of non-standard chemotherapy regimen, or dose reduction due to anaemia and denial of blood transfusion. Twenty-seven percent (n = 17) received hematopoietic growth factors (erythropoiesis-stimulating agents and pegfilgrastim). There was no mortality directly attributed to anaemia or refusal of blood transfusion in the entire cohort. CONCLUSION Jehovah's Witnesses declined RBC transfusion at diagnosis and during cancer therapy even if medically indicated. Management pathways need to be prospectively defined for this group of patients.
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Affiliation(s)
| | - Shawgi Sukumaran
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | - Bogda Koczwara
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | | | - Ganessan Kichenadasse
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | - Amitesh Roy
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | - Sina Vatandoust
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | - Chris Karapetis
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
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6
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Rajtar M. Relational autonomy, care, and Jehovah's Witnesses in Germany. Bioethics 2018; 32:184-192. [PMID: 29369377 DOI: 10.1111/bioe.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 11/27/2017] [Accepted: 12/12/2017] [Indexed: 06/07/2023]
Abstract
Drawing from an ethics of care, relational approaches to autonomy have recently emerged in bioethics. Unlike individual autonomy with its emphasis on patients' rights, choice, and self-determination which has been the hallmark of bioethics consistent with the ideology of individualism in neoliberal democracies in Western countries, relational autonomy highlights the relatedness, interdependency, and social embeddedness of patients. By examining the mediating role that male Hospital Liaison Committee members in Germany play in facilitating care that supports Jehovah's Witnesses' refusal of blood transfusions, this article moves beyond 'dyadic relations' and contexts of caregiving. It also contributes to a deeper understanding of care and relational conceptualizations of Witness patients' autonomy globally.
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Abstract
BACKGROUND Drug-induced immune hemolytic anemia (DIIHA) is a rare condition that may result from the administration of an antibiotic, most notably the cephalosporin class, commonly used in both the adult and pediatric populations. A delay in recognition by a provider may lead to continuation of the offending agent and possibly result in fatal outcomes. CASE REPORT We report the case of a 65-year-old woman on ceftriaxone infusions after being diagnosed with acute mitral valve endocarditis 3 weeks prior, which presented with severe anemia and bilateral transient vision loss. Being a Jehovah's Witness, the patient refused blood product transfusions and was managed with alternative therapies. The etiology of the symptoms was suspected to be a hemolytic anemia directly related to her ceftriaxone infusions. CONCLUSIONS This report demonstrates the importance of close vigilance while prescribing drugs known to cause hemolytic anemia. Although rare, drug-induced immune hemolytic anemia caused by ceftriaxone may be a potentially fatal condition, but with early recognition and withdrawal of the offending agent, successful treatment may ensue. Serological tests should be utilized to obtain a definitive diagnosis.
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Affiliation(s)
- James Tasch
- Graduate Medical Education, Arnot Ogden Medical Center, Elmira, USA
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8
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Jeong JY, Jee HS, Koo BS, Cho SH, Kim SH, Kim G. Liver transplantation in Jehovah's Witnesses: two cases report. Korean J Anesthesiol 2016; 70:350-355. [PMID: 28580088 PMCID: PMC5453899 DOI: 10.4097/kjae.2017.70.3.350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/02/2016] [Accepted: 10/02/2016] [Indexed: 12/13/2022] Open
Abstract
Liver transplantation is especially challenging in patients who are Jehovah's Witnesses because their religious beliefs prohibit the receipt of blood products. We present two cases of living donor liver transplantation performed in adult Jehovah's Witnesses in South Korea without the use of blood products. In the first case, preoperative erythropoiesisstimulation therapy increased hemoglobin levels from 8.1 to 13.1 g/dl after 9 weeks. In the second case, hemoglobin levels increased from 7.4 to 10.8 g/dl after 6 months of erythropoiesis-stimulation therapy. With the combination of acute normovolemic hemodilution, intraoperative cell salvage, and use of transfusion alternatives, liver transplantation was successfully performed without transfusion of blood products.
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Affiliation(s)
- Ju-Young Jeong
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyeon Sook Jee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bon-Sung Koo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung-Hwan Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sang-Hyun Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - GaabSoo Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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9
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Rajtar M. Health care reform and Diagnosis Related Groups in Germany: The mediating role of Hospital Liaison Committees for Jehovah's Witnesses. Soc Sci Med 2016; 166:57-65. [PMID: 27542103 DOI: 10.1016/j.socscimed.2016.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
Resulting from health care reform in Germany that was implemented in 2003-2004, a new medical classification system called the "Diagnosis Related Groups" (DRGs) was introduced in hospitals. According to the media, social scientists, and a few physicians interviewed in this study the policy negatively transformed the German health care system by allowing the privatization of the hospital sector consistent with the neoliberal health care model. Allegedly, this privileged economic values over the quality of health care and introduced competition between hospitals. Nevertheless, members of the Hospital Liaison Committees (HLCs) of Jehovah's Witnesses argued that the DRGs system could be used to the advantage of Jehovah's Witness (JW) patients. HLCs often assist in the patient's search by providing names of physicians that would be willing to refrain from blood transfusions. This article draws from nine months of ethnographic research with Jehovah's Witnesses, including members of the HLCs, carried out primarily in Berlin between 2010 and 2012. By focusing on JWs, whose refusal of blood transfusions is often exemplified as particularly difficult for the biomedical profession, it addresses the "unintended" consequences of the introduction of DRGs into the German health care system that remain unexplored by health and social science scholarship. It argues that although JWs have long been associated with the judicialization of religious freedom globally, they do not equally engage in the judicialization of health in countries such as Germany. The reason for this is embedded not only in health care policy that favors mediation over medical malpractice litigation. It also results from the synergy of health care reforms that prioritize standardizing and economizing measures such as DRGs as well as practices implemented by Patient Blood Management programs that JW institutions, such as HLCs, have tapped into.
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Affiliation(s)
- Małgorzata Rajtar
- Department of Ethnology and Cultural Anthropology, Adam Mickiewicz University, ul. Umultowska 89D, 61-614 Poznań, Poland.
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10
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Abstract
Blood transfusions belong to standard and commonly utilised biomedical procedures. Jehovah's Witnesses' transfusion refusals are often referred to in bioethical and medical textbooks. Members of this globally active religious organisation do not, however, challenge biomedical diagnosis and treatment as such. A result of both their trust in and their interpretation of the Bible, they question only this medical treatment. In spite of the global presence of this religious community and its uniformly practised teachings, including those pertaining to blood, experiences and choices of Jehovah's Witness patients have been understudied. Drawing on a nine-month fieldwork with Jehovah's Witnesses and physicians in Germany (mainly in Berlin) between 2010 and 2012, the paper addresses treatment choices made by Witness patients and their relationship with physicians. In light of the long tradition of 'medical heterodoxy' established in German culture and society, Germany constitutes an ideal point of departure for such a study. By utilising the concept of 'medical landscape' it is argued that Jehovah's Witnesses in my field site find themselves at the intersection of different medical landscapes: in the 'immediate' surroundings of the German healthcare system that is open to different 'treatment modalities', and that of the United States, which favours biomedicine. The paper also argues that Jehovah's Witnesses' position towards blood transfusions can further be used as a lens to shed light on the German (bio)medical landscape itself.
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Affiliation(s)
- Małgorzata Rajtar
- a Department of Ethnology and Cultural Anthropology , Adam Mickiewicz University , Umultowska 89D, Poznan 61-614 , Poland
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Woo DE, Lee JM, Kim YK, Park YH. Recombinant Human Erythropoietin Therapy for a Jehovah's Witness Child With Severe Anemia due to Hemolytic-Uremic Syndrome. Korean J Pediatr 2016; 59:100-3. [PMID: 26958070 PMCID: PMC4781730 DOI: 10.3345/kjp.2016.59.2.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/02/2014] [Accepted: 10/20/2014] [Indexed: 11/27/2022]
Abstract
Patients with hemolytic-uremic syndrome (HUS) can rapidly develop profound anemia as the disease progresses, as a consequence of red blood cell (RBC) hemolysis and inadequate erythropoietin synthesis. Therefore, RBC transfusion should be considered in HUS patients with severe anemia to avoid cardiac or pulmonary complications. Most patients who are Jehovah's Witnesses refuse blood transfusion, even in the face of life-threatening medical conditions due to their religious convictions. These patients require management alternatives to blood transfusions. Erythropoietin is a glycopeptide that enhances endogenous erythropoiesis in the bone marrow. With the availability of recombinant human erythropoietin (rHuEPO), several authors have reported its successful use in patients refusing blood transfusion. However, the optimal dose and duration of treatment with rHuEPO are not established. We report a case of a 2-year-old boy with diarrhea-associated HUS whose family members are Jehovah's Witnesses. He had severe anemia with acute kidney injury. His lowest hemoglobin level was 3.6 g/dL, but his parents refused treatment with packed RBC transfusion due to their religious beliefs. Therefore, we treated him with high-dose rHuEPO (300 IU/kg/day) as well as folic acid, vitamin B12, and intravenous iron. The hemoglobin level increased steadily to 7.4 g/dL after 10 days of treatment and his renal function improved without any complications. To our knowledge, this is the first case of successful rHuEPO treatment in a Jehovah's Witness child with severe anemia due to HUS.
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Affiliation(s)
- Da Eun Woo
- Department of Pediatrics, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae Min Lee
- Department of Pediatrics, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Yu Kyung Kim
- Department of Laboratory Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Yong Hoon Park
- Department of Pediatrics, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
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12
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Munekage M, Kohsaki T, Uemura S, Kitagawa H, Namikawa T, Hanazaki K. Mucinous cystadenocarcinoma of the pancreas with anaplastic carcinoma: A case report and review of the literature. Mol Clin Oncol 2016; 4:483-486. [PMID: 27073646 PMCID: PMC4812127 DOI: 10.3892/mco.2016.743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/21/2015] [Indexed: 12/17/2022] Open
Abstract
Few reports of mucinous cystic neoplasm (MCN) in association with anaplastic carcinoma exist. The present study reported an unusual case of a 25-year-old female exhibiting large pancreatic MCN with anaplastic carcinoma. Notably, the patient was a Jehovah's Witness and therefore refused any blood transfusions. Preoperative diagnosis was invasive pancreatic MCN measuring 12.5 cm with ascites. Distal pancreatectomy was performed in combination with splenectomy and partial resection of the transverse colon. Intraoperative estimated blood loss was 400 ml, therefore a blood transfusion was not required. The patient had an uneventful postoperative course. The pathological diagnosis was mucinous cystadenocarcinoma of the pancreas with anaplastic carcinoma. Although the patient underwent postoperative adjuvant chemotherapy with gemcitabine and oral fluoropyrimidine (S-1), recurrence with peritoneal dissemination was detected 20 months following surgery and the patient succumbed to the recurrence 32 months following surgery. To the best of our knowledge, this is the first case report of MCN with anaplastic carcinoma of the pancreas in a Jehovah's Witness patient undergoing pancreatic surgery.
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Affiliation(s)
- Masaya Munekage
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Takuhiro Kohsaki
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
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13
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Garelius H, Grund S, Stockelberg D. Induction with azacytidine followed by allogeneic hematopoietic stem cell transplantation in a Jehovah's Witness with acute monocytic leukemia. Clin Case Rep 2015; 3:287-90. [PMID: 25984306 PMCID: PMC4427369 DOI: 10.1002/ccr3.212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 10/18/2014] [Accepted: 12/07/2014] [Indexed: 11/12/2022] Open
Abstract
We have used a hypomethylating agent instead of conventional chemotherapy to induce remission in a young Jehovah's Witness with acute monocytic leukemia to avoid severe myelosuppression and blood product support. The treatment was consolidated with reduced intensity allogeneic stem cell transplantation. This could be an alternative when transfusions must be avoided.
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Affiliation(s)
- Hege Garelius
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital Gothenburg, Sweden
| | - Sofia Grund
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital Gothenburg, Sweden
| | - Dick Stockelberg
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital Gothenburg, Sweden
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14
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Trzciński R, Kujawski R, Mik M, Berut M, Dziki Ł, Dziki A. Surgery in Jehovah's Witnesses - our experience. Prz Gastroenterol 2015; 10:33-40. [PMID: 25960813 DOI: 10.5114/pg.2014.47496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/20/2014] [Accepted: 07/03/2014] [Indexed: 12/03/2022]
Abstract
Introduction Surgeons face a special challenge in treating Jehovah's Witnesses who refuse blood transfusion. Aim To present our surgical experience with this group of patients operated on in our department. Material and methods A retrospective study of 16 unselected Jehovah's Witnesses patients was conducted between October 2004 and February 2012. We analysed gender, age, haemogram before and after surgery, types of surgery, postoperative complications and the need for blood transfusion, and/or other drugs stimulating erythrogenesis. Results Eighty-one percent of patients were women; the average age of all patients was 57.3 years. Mean haemoglobin level, preoperative, postoperative, and on the day of discharge from hospital, was 12.5 g/dl, 9.7 g/dl, and 9.29 g/dl, respectively. Over the same time period, mean red blood cell count was 4.53 mln/µl, 3.58 mln/µl, and 3.37 mln/µl, respectively. Two out of 16 patients agreed to have blood transfusion. Drugs used for erythropoiesis stimulation included rEPO, ferrum, and folic acid. No surgical death was noted. Conclusions We found that abdominal surgery was safe in our small group of Jehovah's Witness patients. However, all Jehovah's Witness patients should be fully informed about the type of procedure and possible consequences of blood transfusion refusal. Two of our patients agreed to blood transfusion in the face of risk of death.
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Martin LP, Arias-Gallo J, Perez-Chrzanowska H, Seco PR, Moro JGM, Burgueño-Garcia M. Transfusion Requirements in Microsurgical Reconstruction in Maxillofacial Surgery: Ethical and Legal Problems of Patients Who Are Jehovah's Witnesses. Craniomaxillofac Trauma Reconstr 2014; 6:31-6. [PMID: 24436733 DOI: 10.1055/s-0033-1333828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/06/2012] [Indexed: 10/27/2022] Open
Abstract
Objective To study transfusion requirements in patients with cancer undergoing head and neck reconstructive surgery and to discuss surgical and anesthetic strategies to reduce blood loss when the patient is a Jehovah's Witness. Material and Methods A descriptive study to expose the percentage of blood transfusions performed in patients with cancer undergoing microsurgical reconstructions in the department of oral and maxillofacial surgery of the referred hospital in the past 9 years. Results Two hundred thirty-seven microsurgical reconstructions were performed in head and neck tumors between January 2001 and December 2009. Statistical analysis shows a significant decrease (p = 0.035) in the number of patients needing transfusions patients in recent years. Conclusions The treatment of patients who are Jehovah's Witnesses is an ethical and moral dilemma for the clinician and in particular for surgeons.
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Perrotti A, Vaislic C, Chocron S. Aortic valve replacement and repair of left ventricular pseudoaneurysm in a Jehovah's Witness. Res Cardiovasc Med 2013; 2:70-3. [PMID: 25478494 PMCID: PMC4253751 DOI: 10.5812/cardiovascmed.7274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/16/2022] Open
Abstract
The preoperative and surgical management of a giant left ventricular pseudoaneurysm(LVP) associated with aortic valve replacement in a 76 year old male Jehovah’s Witness patient is reported. The satisfactory recovery observed in this patient demonstrates the feasibility of this complex surgical procedure even in this particular patient population.
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Affiliation(s)
- Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, EA3920, University Hospital Jean Minjoz, 25000, Besançon, France
- Corresponding author: Andrea Perrotti, Department of Thoracic and Cardiovascular Surgery, EA3920, University Hospital Jean Minjoz, 25000, Besançon, France. Tel.: +33-0381668664, Fax: +33-0381668661, E-mail:
| | - Claude Vaislic
- Centre Medico-chirurgical Parly II, 21 rue Moxouris, 78150, Le Chesnay, France
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17
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Henn LW, Esmailian F. Repair of a large main pulmonary artery aneurysm in a 71-year-old Jehovah's Witness patient. Tex Heart Inst J 2013; 40:350-352. [PMID: 23914038 PMCID: PMC3709207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pulmonary artery aneurysm is a rarely reported and poorly studied entity; most mentions in the literature are in case series and case reports. Cardiac surgery in Jehovah's Witness patients is occurring more frequently because of improved techniques of blood conservation. We report the repair of a large pulmonary artery aneurysm in a 71-year-old woman who was a Jehovah's Witness. Using total cardiopulmonary bypass, we replaced the main pulmonary artery and both branches with Gelweave tube-grafts, because the fragility of a homograft presented possible bleeding problems. The patient recovered rapidly, and her symptoms were greatly improved. We think that a patient's status as a Jehovah's Witness need not preclude potentially life-saving cardiac operations.
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Affiliation(s)
- Lucas W Henn
- Department of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California 90048, USA.
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Lin ES, Kaye AD, Baluch AR. Preanesthetic Assessment of the Jehovah's Witness Patient. Ochsner J 2012; 12:61-69. [PMID: 22438784 PMCID: PMC3307508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
The Jehovah's Witnesses, a religious group of 7 million people in more than 200 countries, teaches its followers to not accept blood, resulting in potentially challenging and ethical dilemmas for anesthesiologists. In recent years, Jehovah's Witnesses changed certain elements of their approach to blood transfusion practice, including accepting autologous transfusions in certain circumstances. We examine mechanisms to resolve ethical conflicts, such as additional medical consultations with other involved physicians, surgeons, and anesthesiologists; short-term counseling or psychiatric consultation for patient and family; case management conferences; consultation with individuals trained in clinical ethics or a hospital-based ethics committee; and discussions with hospital administration. We also discuss treatment options, including certain blood products, anesthetic techniques, and pharmacological interventions.
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Affiliation(s)
- Eric S. Lin
- Medical Student, Louisiana State University School of Medicine, New Orleans, LA
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA
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Lee JM, Byon HJ, Kim JT, Kim HS, Kim CS. Transfusion-free anesthetic management for open heart surgery in a neonate -A case report-. Korean J Anesthesiol 2011; 59 Suppl:S141-5. [PMID: 21286425 PMCID: PMC3030021 DOI: 10.4097/kjae.2010.59.s.s141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 08/06/2010] [Accepted: 08/19/2010] [Indexed: 11/10/2022] Open
Abstract
In small infants or neonates, open heart surgery without transfusion can have many risks regarding inadequate oxygen delivery and coagulopathy. However, if parents refuse blood transfusion, cardiac surgery without transfusion should be considered. We report a case of bloodless cardiac surgery in a 2.89 kg neonate with Jehovah's Witness parents. Blood conserving strategies were used. Preoperatively, erythropoietin and iron were supplemented to increase the hemoglobin level. Intraoperatively, techniques for minimizing blood loss were used, such as reducing priming volume for cardiopulmonary bypass, a blood salvage system, and modified ultrafiltration. Postoperatively, pharmacologic agents were administered and blood sampling was minimized.
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Affiliation(s)
- Jung Min Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Huebler M, Habazettl H, Boettcher W, Kuppe H, Hetzer R, Redlin M. Transfusion-free complex cardiac surgery: with use of deep hypothermic circulatory arrest in a preterm 2.96-kg Jehovah's witness neonate. Tex Heart Inst J 2011; 38:562-564. [PMID: 22163136 PMCID: PMC3231527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In neonates, the major obstacle to transfusion-free complex cardiac surgery is the severe hemodilution that can result from the mismatch between the priming volume of the circuit and the patients' blood volume. Herein, we report the case of a 13-day-old, 2.96-kg preterm neonate who had a hypoplastic aortic arch and atrial and ventricular septal defects. At the insistence of her Jehovah's Witness parents, we performed corrective surgery without transfusing homologous blood products--using deep hypothermic circulatory arrest in the process. A specially designed cardiopulmonary bypass circuit with a priming volume of only 95 mL was the key component of an interdisciplinary effort to avoid transfusion while maintaining the patient's safety. To our knowledge, this is the 1st report of the use of deep hypothermic circulatory arrest in blood-transfusion-free surgery to correct congenital heart defects in a small Jehovah's Witness neonate.
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Affiliation(s)
- Michael Huebler
- Department of Cardiothoracic & Vascular Surgery, German Heart Institute, 13353 Berlin, Germany
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