How do you manage patients who refuse transfusions?
Alternatives to blood product usage include blood salvaging techniques, such as the use of cell savers, or pharmacological interventions, such as intravenous iron and erythropoietin. These options are not always easily available in South Africa at present, particular in the public sector, nor suitable for the acute emergency scenario. The autonomy of the patient, after adequate explanation of the risks and benefits of the blood therapy during the informed consent procedure, should be respected. The management of Jehovah’s Witness patients who may need blood product transfusions requires a detailed discussion between the clinician and patient as to what blood components they may be willing to receive. While the standard blood products issued from the blood bank (eg. red cell concentrates, platelets and plasma units) and stored autologous donations are prohibited, some Jehovah’s Witness patients are willing to receive fractionated plasma products (eg. coagulation factors) and undergo cell salvage procedures. In the event that you are informed that an unconscious patient may be a Jehovah’s Witness follower, check if they are carrying a durable power of attorney card that specifies that they do not want to receive transfusions and who should be contacted to verify this. The Jehovah’s Witness Hospital Liaison Committees can be approached for assistance and mediation – contact details and additional clinical information can be accessed via their website.