Abstract

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.

Author Details

Anne (Afia) Owusu, BSN, RN; Lauren Barnes, DNP, CRNA

Sigma Membership

Non-member

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Qualitative Research

Keywords:

Jehovah's Witnesses, Blood Transfusion, Patient Beliefs Related to Healthcare, Surgeries

Advisor

Barnes, Lauren

Degree

DNP

Degree Grantor

Samford University

Degree Year

2024

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2024-01-26

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