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n Obstetrics and Gynaecology Forum - A Jehovah’s witness with haemolytic anaemia in pregnancy refuses blood transfusion : case report

Volume 30 Number 1
  • ISSN : 1029-1962

Abstract

Introduction: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity globally. The Jehovah’s Witness religion is a Christian denomination with at least 7 millions of members worldwide, these tallies continue to grow annually. Jehovah’s Witnesses are well-known for their refusal to receive blood transfusions. This situation can place the medical practitioners involved in the management of Jehovah’s Witness patients in difficult medicolegal dilemmas.

Objective: To present a case report of pregnant woman who is a member of Jehovah’s Witness faith, with haemolytic anaemia, who declined blood transfusion and to review different strategies in the management of women in pregnancy for whom transfusion of blood is not an option.

Findings: Appropriate management of a Jehovah’s Witness patient entails understanding of the legal and ethical issues involved. Individual interpretations of doctrine may vary, therefore it is critical that physicians explore these issues with their patients clearly and without judgment. Meticulous medical management with early diagnosis or identification of risk factors for postpartum haemorrhage followed by immediate treatment is essential in pregnant patients who refuse blood transfusion or whom transfusion of blood is not an option. Medical management options in treating anaemia include iron, folate supplementation and erythropoietin. Postpartum haemorrhage should be managed aggressively in stepwise fashion and definitive lifesaving steps should generally be made earlier than usual. Options to decrease morbidities and mortalities associated with postpartum haemorrhage are now available which include medical treatment with anti-fibrinolytics, recombinant Factor VII and factor concentrates, autologous blood transfusion, if acceptable to the woman, deliberate hypothermia and hypotensive anaesthesia. Close monitoring in high dependency care or ICU is advisable for the patient who experienced postpartum haemorrhage.

Conclusion: It is important for the clinicians taking care of the Jehovah’s Witnesses to have a rudimentary understanding of their philosophy about blood transfusion to facilitate proactive management. All maternity health care practitioners should be familiar with alternatives options for the management of patients who refuse blood transfusions.

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2020-03-01
2020-09-23

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