Lindstrom Eric, Johnstone Robert
West Virginia University, Morgantown, USA.
AANA J. 2010 Aug;78(4):326-30.
Patients who are Jehovah's Witnesses refuse blood transfusions and blood products as a matter of faith. For surgical procedures during which substantial blood loss is possible, their refusal presents a challenge. 'Anesthetists must generally respect the requests of adults not to receive blood and thus should have a clear understanding of how they will respond in the event of bleeding. Several blood conservation techniques are available for consideration, including acute normovolemic hemodilution. This technique entails the preoperative phlebotomy of whole blood that contains a high concentration of red blood cells and coagulation Patiefactors, while replacing the lost volume with a crystalloid and/or colloid infusion. The procured whole blood can then be transfused back during or after the procedure as a treatment of hypovolemia. Leaving the procured blood continuously attached to the patient through the collection tubing makes the procedure acceptable to most Jehovah's Witness patients. Current literature is unclear when this technique should be used. In this particular case, acute normovolemic hemodilution contributed to the successful outcome of an anemic Jehovah's Witness who was undergoing major surgery.
耶和华见证人的患者出于信仰拒绝输血和血液制品。对于可能出现大量失血的外科手术，他们的拒绝带来了挑战。麻醉师通常必须尊重成年人不接受输血的请求，因此应该清楚了解在出血情况下他们将如何应对。有几种血液保护技术可供考虑，包括急性等容血液稀释。该技术需要在术前采集含有高浓度红细胞和凝血因子的全血，同时用晶体液和/或胶体液输注来补充丢失的血容量。然后，采集的全血可在手术期间或术后回输，作为治疗低血容量的方法。通过采集管道将采集的血液持续与患者相连，这使得该方法为大多数耶和华见证人的患者所接受。目前的文献尚不清楚何时应使用该技术。在这个特殊病例中，急性等容血液稀释促成了一名正在接受大手术的贫血耶和华见证人患者的成功治疗。
