Strategies for Controlling Haemorrhage
and Anaemia Without Blood Transfusion
1.
Surgical Devices and Techniques to Locate
and Arrest Internal Bleeding:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
2.
b.
a.
b.
c.
d.
e.
f.
g.
h.
i.
4.
b.
c.
6.
Hypotensive anaesthesia
Regional anaesthesia
Maintain normothermia
Acute normovolemic haemodilution
Intraoperative and postoperative blood salvage
Mechanical occlusion of bleeding vessel
Meticulous haemostasis
Trauma - Quick response and rapid re-warming
Preoperative planning
(1) Enlarged surgical team/Minimal time
(2) Surgical positioning
(3) Staging of complex procedures
Blood-Oxygen Monitoring Devices and
Techniques that Limit Blood Sampling:
a.
b.
c.
d.
Transcutaneous pulse oximeter
Pulse oximeter
Paediatric microsampling equipment
Multiple tests per sample – Plan ahead!
b.
c.
7.
Crystalloids
(1) Ringer’s lactate, Hartmann’s solution
(2) Glucose (dextrose)
(3) Isotonic or hypertonic saline
Colloids
(1) Gelatins
(2) Pentastarch
(3) Hetastarch
Perfluorochemicals
(1) Oxygent
Haemostatic Agents for
Bleeding/Clotting Problems:
a.
For bleeding:
(1) Applied direct pressure
(2) Ice packs
(3) Positioning of body
(4) Haemostatic agents (see No. 6.)
(5) Prompt surgery
(6) Tourniquet
For shock:
(1) Trendelenburg/shock position (patient
supine with head lower than legs)
(2) Medical Antishock Trousers (MAST)
(3) Appropriate volume replacement after
bleeding controlled
Operative and Anaesthetic Techniques to
Limit Blood Loss During Surgery:
Volume Expanders:
a.
Techniques and Devices to Control
External Bleeding and Shock:
a.
3.
Electrocautery or Electrosurgery
Laser surgery
Argon beam coagulator
Gamma knife radiosurgery
Microwave coagulating scalpel
Shaw haemostatic scalpel
Endoscopy or Laparoscopy
Arterial embolization
Ultrasonic Scalpel
Tissue adhesives
Cryosurgery
5.
Topical:
(1) Avitene
(2) Gelfoam
(3) Oxycel
(4) Surgicel
(5) Many others
Injectable:
(1) DDAVP, Desmopressin
(2) E-Aminocaproic acid
(3) Tranexamic acid
(4) Vitamin K
(5) Recombinant Factor VIIa or VIII
Other Drugs:
(1) Vasopressin
(2) Conjugated Oestrogens
(3) Aprotinin
Therapeutic Agents and Techniques for
Managing Anaemia:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Stop the bleeding!
Oxygen support
Maintain intravascular volume
Iron (Venofer®)
Folic acid
Hyperbaric oxygen chamber
Mechanical ventilation
Vitamin B12 intramuscular injection
Immunosuppressive agents if indicated
Recombinant Erythropoietin
Granulocyte-Colony Stimulating Factor
Granulocyte Macrophage-Colony Stim/Factor
m. 10/30 rule for minimum red cell level has no
scientific basis
n. Nutritional support
o. Anabolic androgenic hormones (DecaDurabolin 100)
Jehovah’s Witnesses’ Position on
Medical Treatment
 Will accept all other kinds of
medical treatment except blood
 Are not exercising a right to die
 Are keen to co-operate with
medical professionals
 Do not try to stop others having
blood
What Jehovah's Witnesses
Won’t Accept
1.
2.
3.
4.
5.
6.
Transfusions of whole blood
Red cells
Plasma
Platelets
White cells
Predonated autologous blood
What Jehovah's Witnesses Will Accept
1.
2.
3.
4.
5.
6.
Ringer's Lactate
Normal Saline
Hypertonic Saline
Pentastarch
Hetastarch
Gelatins (Gelofusine/Haemaccel)
The Role of the Hospital Liaison Committee
A network of over 1,400 Hospital Liaison
Committees has been established worldwide.
The prime role of these committees is to assist
in avoiding confrontation between doctor and
patient and to assist understanding on both
sides.
The Stoke on Trent Hospital Liaison Committee is
pleased to offer a free lecture service to hospitals,
medical schools, blood transfusion centres and
postgraduate departments.
Lectures can be tailored to suit most requirements.
Also lectures can include the Video:-
The Hospital Liaison Committee can:

Provide medical articles and information about
the latest developments in bloodless surgical
and medical management.

Provide a contact list of consultant surgeons
and physicians who are willing to work with
Jehovah's Witnesses without the use of blood
or major blood products.

Put surgeons and physicians in contact with
one another in order to share the benefits of
experience and good practice.
“The local ‘Hospital Liaison Committee for
Jehovah's Witnesses’ can also act as a local
resource for information regarding the beliefs and
practices of Jehovah's Witnesses. They have
access to a great deal of reference material and
information.” — Management of Anaesthesia for
Jehovah's Witnesses (The Association of
Anaesthetists of Great Britain and Ireland, 1999)
ADDITIONAL SOURCES OF INFORMATION
The following publications are recommended as
essential reading for physicians and surgeons
involved in treating Jehovah's Witnesses: —

Matters of Conscience
1. Fractions derived from any primary
component of blood. e.g. anti-D
2. Medical procedures involving the use
of autologous blood that do not
involve storage. e.g. Intra-operative
cell salvage
3. Organ transplant
LECTURE SERVICE

Code of Practice for the Surgical
Management of Jehovah's Witnesses —
The Royal College of Surgeons of England
(1996)
Management of Anaesthesia for Jehovah's
Witnesses — The Association of
Anaesthetists of Great Britain and Ireland
(1999)
TRANSFUSION – ALTERNATIVE
STRATEGIES
Simple  Safe  Effective
Alternatives to blood transfusion in surgery are
possible and have proved safe and effective.
Blood conservation and avoidance of allogeneic
transfusion are fast becoming desirable end points
in clinical practice. This video reviews the methods
available to achieve this outcome and shows how
they are applied in standard surgical practice. With
emphasis on simple, cost-effective steps, it shows
how to implement a comprehensive strategy that
begins with preoperative management and integrates techniques in the domains of both the
surgeon and the anaesthesiologist. Internationally
renowned expert practitioners describe their
experiences and explain how each method is used
as part of an overall strategy based on three main
principles. Health-care teams will appreciate this
practical overview of multi-modal transfusion
alternatives and explanation of how to combine
them cost effectively and easily in the management
of individual patients.
To arrange for a lecture and /or see video
Please contact:
Peter Warren on 01782 313014