Jehovah's Witnesses: unique problems in a unique trauma population

Jehovah's Witnesses can create perplexing treatment problems by their refusal of blood transfusions. This dilemma is especially difficult for the trauma surgeon faced with critically low hemoglobin levels or life-threatening blood loss in an injured Jehovah's Witness.

Retrospective review of the records of 58 Jehovah's Witnesses admitted to a single trauma center between July 1992 and June 1995.

There were 53 blunt and 5 penetrating injuries. Four patients (7 percent) received blood transfusions; one received banked blood and three received autotransfusions. Two patients were sedated and paralyzed to optimize oxygen utilization; one patient received erythropoietin. Eighteen patients had a general anesthetic and underwent an operative procedure; one underwent controlled hypotensive anesthesia with normovolemic hemodilution. The records of 21 patients (36 percent) included documentation of absolute refusal of blood or blood products; the exact status of consent for blood transfusion was not documented in the records of 33 patients (57 percent). One death and six complications occurred, none of which were attributed to acute blood loss or anemia. Treatment options and special techniques for the severely anemic patient refusing blood transfusions are discussed.

Documentation of religious status and beliefs about blood transfusion, as well as knowledge of special treatment options available for anemic Jehovah's Witnesses, is necessary to provide quality care to this unique trauma population.