Quick Reference: Jehovah’s Witness

Even though it is
commonly accepted that the Jehovah’s Witnesses will not receive any blood
products, this varies from patient to patient. 
Therefore, it is recommended that each individual patient be presented
with all possible options, in an effort to better assess the individual’s
personal convictions in relation to transfusion.

1. Fluids:  Crystalloid fluid only, colloid
   administration should be Hespan or Dextran.
2. If
   possible, patients should be placed on Erythropoietin as far in advance of
   surgery as possible.  Hematocrit should
   be ≥36% prior to surgery and Erythropoietin continued until patient discharge
   for a hematocrit less than 30%.
3. If
   the patient will allow autologous blood donation in the O.R. suite, this
   procedure should be maximized to sequester as much blood as possible, only to
   be reinfused after the protamine.
4. Priming
   volume should be kept to a minimum.  
5. Consider Retrograde Autologous Prime (RAP).
6. Diuretics
   and hemoconcentration should be aggressively used during CPB.  Mannitol may be used:  12.5 Gm in prime, 12.5 Gm when beginning to
   rewarm, 12.5 Gm just prior to coming off CPB (institutional specific).
7. Exclusive
   use of intraoperative cell saver.  All
   blood salvaged and continuously reinfused through the cell saver in a closed
   circuit.  Minimize use of laps, sponges,
   and discard suckers. The entire bypass circuit
   should also be processed.
8. Modified
   Ultrafiltration (MUF) has proven to be quite effective in the Jehovah’s
   Witnesses population.  It is not uncommon
   to raise the patient’s hematocrit 3-7% with MUF in a 20-minute time period (e.g., raised from Hct 23% to 28% in 20
   minutes).
9. All
   chest tube drainage should be reinfused if chest drainage is >50 ml/hr. for
   the first 8 hours post-op. CardioPAT is preferred if available.
10. If
    the patient has well-preserved ventricular function, SVR should be maintained
    at ≥1000 in an attempt to decrease the circulating vascular volume.
11. Great
    attention should be given to anticoagulation and heparin reversal to prevent
    heparin rebound post-operation. TEG is a good option if available.