Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon.
Patient Blood Management Program, Oregon Health and Science University, Portland, Oregon.
Am J Hematol. 2017 Dec;92(12):1370-1381. doi: 10.1002/ajh.24889. Epub 2017 Sep 29.
By virtue of their religious principles, Jehovah's Witnesses (JWs) generally object to receiving blood products, raising numerous ethical, legal, and medical challenges for providers who care for these patients, especially in the emergent setting. In this review, we discuss several areas relevant to the care of JWs, including the current literature on "bloodless" medical care in the setting of perioperative and intraoperative management, acute blood loss, trauma, pregnancy, and malignancy. We have found that medical and administrative efforts in the form of bloodless medicine and surgery programs can be instrumental in helping to reduce risks of morbidity and mortality in these patients. Planning prior to an anticipated event associated with blood loss or anemia (such as elective surgery, pregnancy, and chemotherapy) is critical. Specifically, bloodless medicine programs should prioritize vigilant early screening and management of anemias, early establishment of patient wishes regarding transfusion, and the incorporation of those wishes into multidisciplinary medical and surgical care. Although there are now a variety of human-based and nonhuman-based products available as transfusion alternatives, the degree and quality of evidence to support their use varies significantly between products and is also largely dependent on the clinical setting.
由于宗教原则，耶和华见证人（Jehovah's Witnesses，JWs）通常反对接受血液制品，这给照顾这些患者的医务人员带来了众多伦理、法律和医疗方面的挑战，尤其是在紧急情况下。在这篇综述中，我们讨论了与 JW 患者护理相关的几个领域，包括围手术期和手术期间管理、急性失血、创伤、妊娠和恶性肿瘤中“无血”医疗的当前文献。我们发现，以无血医学和手术计划的形式进行医疗和行政方面的努力，可以帮助减少这些患者的发病率和死亡率风险。在与失血或贫血相关的预期事件（如择期手术、妊娠和化疗）之前进行计划至关重要。具体来说，无血医学计划应优先考虑对贫血的警惕性早期筛查和管理，早期确定患者对输血的意愿，并将这些意愿纳入多学科医疗和手术护理中。尽管现在有多种基于人类和非人类的产品可作为输血替代品，但支持其使用的证据程度和质量在产品之间存在显著差异，并且在很大程度上也取决于临床环境。
