Anaes SAQs · Perioperative medicine
Jehovah's Witness and bloodless perioperative care
Final-examination SAQ for jehovahs-witness-transfusion.
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ANZCAFRCAEDAICABAFCAI
Prompt
A 55-year-old Jehovah's Witness requires elective open nephrectomy. Hb 104 g/L, ferritin low. Outline ethical, preoperative, and intraoperative management.
Model answer
Ethics (3). Capacity; informed refusal; document exact product/technique acceptance; Liaison Committee if desired; no coercion.[1][2]
Optimise (4). Iron therapy; consider ESA pathway; delay until Hb improved if safe; experienced team.[1][2]
Intraop (4). Meticulous surgery, TXA, continuous ICS if accepted, normothermia, POC Hb, minimise samples.[3]
Crisis plan (2). Senior help, IR/surgical control, oxygen delivery optimisation without primary components if refused.[2]
Decline/defer (2). If risk unacceptable after optimisation discussion.[1][2]
References3ShowHide
- [1]Lawson T, Ralph C Perioperative Jehovah's Witnesses: a review. British Journal of Anaesthesia, 2015.PMID 26068896
- [2]Klein AA, Bailey CR, Charlton A, et al. Association of Anaesthetists: anaesthesia and peri-operative care for Jehovah's Witnesses and patients who refuse blood. Anaesthesia, 2019.PMID 30270470
- [3]Klein AA, Bailey CR, Charlton AJ, et al. Association of Anaesthetists guidelines: cell salvage for peri-operative blood conservation 2018. Anaesthesia, 2018.PMID 29989144