Dismiss Notice
Hey Texans—join us for a DFW meetup! Click here to learn more.

Jehovah's Witness/preop Type and Screen and CBC

Discussion in 'Anesthesiology' started by Twiggidy, Aug 18, 2015.

  1. Twiggidy

    Twiggidy ASA Member
    2+ Year Member

    Joined:
    Jan 13, 2015
    Messages:
    2,294
    Likes Received:
    2,056
    Thoughts?

    Why?

    Edit: this is for a c/s btw, so i can understand CBC for plt count for regional anesthesia
     
    #1 Twiggidy, Aug 18, 2015
    Last edited: Aug 18, 2015
  2. Note: SDN Members do not see this ad.

  3. pgg

    pgg Laugh at me, will they?
    Moderator Physician Faculty 10+ Year Member

    Joined:
    Dec 14, 2005
    Messages:
    11,525
    Likes Received:
    6,524
    Status:
    Attending Physician
    Did she decline blood products? All of them, or just some of them? Rhogam might be acceptable to her, if indicated.

    She might change her mind.
     
  4. 22031 Alum

    22031 Alum At the baby factory.
    Physician Faculty 7+ Year Member

    Joined:
    Jul 12, 2008
    Messages:
    1,612
    Likes Received:
    4,368
    Status:
    Attending Physician
    Some only refuse whole blood.

    Some only refuse pRBCs.

    Some will change their minds about refusing as you update them on their continued blood loss and the seriousness of their condition - especially if there's a new baby in the room that they want to live for.

    I've seen all of the above, and would prefer having a T&S to not.
     
    VickInABox likes this.
  5. ryanjmy

    10+ Year Member

    Joined:
    May 27, 2008
    Messages:
    69
    Likes Received:
    53
    Cbc could change your management. You might cancel the case plus you have an idea of how much blood a pt can lose before it gets critical. Communicating with the surgeon how bad things are is important. A lot of jw pt wil take cell saver and hemodilution auto transfusions.

    As for t&s, I've heard of pt's families consenting for blood products when it's life or death.

    Edit: Just saw this is a c/s so I guess canceling and cell saver are out.
     
  6. caligas

    caligas ASA Member
    5+ Year Member

    Joined:
    Aug 17, 2012
    Messages:
    1,227
    Likes Received:
    998
    Doesn't matter what family "consents" to, if patient said no blood and is now asleep, no transfusion.
     
    Cytarabine and SouthernSurgeon like this.
  7. Gern Blansten

    Gern Blansten Account on Hold
    10+ Year Member

    Joined:
    Jun 20, 2006
    Messages:
    2,145
    Likes Received:
    294
    Status:
    Attending Physician
    In this situation, there is a different twist to the ethical dilemma that needs to be addressed with the mother so that she can make an informed decision. You must inform her that if she hemorrhages during the procedure, the baby will likely survive, but she may not. So, this new baby, who has no say in the matter, will be forced to grow up without the benefit of their mother's love and guidance. You should likely determine if the mom has considered this and does it impact her decision at all.
     
  8. Twiggidy

    Twiggidy ASA Member
    2+ Year Member

    Joined:
    Jan 13, 2015
    Messages:
    2,294
    Likes Received:
    2,056
    thanks peeps. these are all things i didn't consider. i admittedly approach these patients a little to conservatively sometimes so my initial reaction this morning was, "why the heck are we drawing labs on this person we're not giving blood to anyway?"

    All responses are great and will help me in the future. Thanks
     
  9. 22031 Alum

    22031 Alum At the baby factory.
    Physician Faculty 7+ Year Member

    Joined:
    Jul 12, 2008
    Messages:
    1,612
    Likes Received:
    4,368
    Status:
    Attending Physician
    Luckily for cesareans, the patient is usually awake. When I get to the decision point of more intense interventions (ie hysterectomy) and putting the patient to sleep, we're having a frank discussion about what may happen without transfusion. I've had some patients remain adamant that they won't take any blood products, and sadly, I've seen some of them die because of that decision. (It's sad to me, but there have been families quite at peace with their loved one making that decision, even with a new motherless baby left behind.) But other times, the conviction becomes a lot weaker once the concept of bleeding to death becomes less abstract.
     
  10. dhb

    dhb Member
    Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jul 12, 2006
    Messages:
    3,548
    Likes Received:
    760
    Status:
    Attending Physician
    :wow: hard to believe
     
  11. Mman

    Mman Senior Member
    10+ Year Member

    Joined:
    Mar 22, 2005
    Messages:
    4,183
    Likes Received:
    1,770
    Status:
    Attending Physician
    I've had 1 Jehovah's Witness die from bleeding in the OR. We kept them alive to the ICU with a Hct in the single digits but they died a day or two later. It happens. The vast majority of the time they do fine.
     
  12. BuzzPhreed

    Joined:
    Jan 9, 2014
    Messages:
    1,224
    Likes Received:
    632
    Status:
    Attending Physician
    Uncrossmatched blood if they change their mind. Not a good use of resources, but keeps your ass out of court.

    And I too have seen a patient die who was being coded in the unit with a hemoglobin of < 4. The family said "no blood". How the enforcement of some silly superstitious by proxy belief doesn't constitute homicide is beyond me.
     
  13. Shimmy8

    Shimmy8 ASA Member
    5+ Year Member

    Joined:
    Sep 10, 2012
    Messages:
    244
    Likes Received:
    213
    Status:
    Resident [Any Field]
    Did a C/S today on JW, did a type and screen with the CBC for neuraxial.

    She was potentially abrupting and failed to progress so we went with C/S. Had perfusion in room with cell saver, luckily didn't have to use it.

    Butthole was a little tight until things were under control.
     
  14. kingcer0x

    kingcer0x Re-Member
    10+ Year Member

    Joined:
    Jun 10, 2003
    Messages:
    466
    Likes Received:
    7
    Status:
    Resident [Any Field]
    "Intraoperative cell salvage is a strategy to decrease the need for allogeneic blood transfusion. Traditionally, cell salvage has been avoided in the obstetric population because of the perceived risk of amniotic fluid embolism or induction of maternal alloimmunization. With advances in cell salvage technology, the risks of cell salvage in the obstetric population parallel those in the general population. Levels of fetal squamous cells in salvaged blood are comparable to those in maternal venous blood at the time of placental separation. No definite cases of amniotic fluid embolism have been reported and appear unlikely with modern equipment. Cell salvage is cost-effective in patients with predictably high rates of transfusion, such as parturients with abnormal placentation."

    Cell Salvage in Obstetrics
    Goucher, Haley MD; Wong, Cynthia A. MD; Patel, Samir K. MD; Toledo, Paloma MD, MPH
    Anesthesia & Analgesia
    August 2015
    Vol. 121 - Issue 2: p 465–468

    http://mobile.journals.lww.com/anesthesia-analgesia/_layouts/oaks.journals.mobile/articleviewer.aspx?year=2015&issue=08000&article=00027&ContextualNavigationType=mostviewed
     
    VickInABox likes this.
  15. Docuronium

    Docuronium ASA Member
    7+ Year Member

    Joined:
    Jan 31, 2011
    Messages:
    182
    Likes Received:
    32
    Status:
    Resident [Any Field]
    Keeping up---hot off the presses there
     

Share This Page