EXTRACTS FROM OPINION, DATED FEBRUARY 22, 2024:
“… I would like to briefly outline how the expert medical community manages patients when they do not accept blood transfusions.
Patient Blood Management (PBM) is a compelling practice to pre-empt anaemia, correct bleeding disorders, and minimize blood loss. This evidence based, multidisciplinary approach leads not only to reductions in the use of blood and blood products, and therefore to considerable cost savings, but – more importantly – it also improves patient outcomes and patient safety.
…
There is a compelling need to implement PBM. Any review of the literature on allogeneic (donor) blood transfusion and patient outcomes is sobering. In nonbleeding patients, evidence for the benefit from blood transfusion is scant – even in critically ill patients. Of concern is the large and growing body of literature showing that blood transfusion is independently associated with adverse patient outcomes in a dose-dependent manner. Most studies evaluating the clinical efficacy of transfusion have failed to demonstrate a benefit.
That dose-dependent increase in adverse outcomes associated with allogenic blood transfusion is observed in all areas of clinical practice.
Over the course of my medical career, I have had the opportunity to provide treatment to hundreds of patients who are Jehovah’s Witnesses. In elective and semi-elective situations this patient group can be perfectly prepared for interventions/surgery. … We are always aiming to achieve a Hb-concentration of >13g/dl in women and men. Outcome data of Jehovah’s Witnesses are equal in many situations where major surgical bleeding is occurring. … Length of stay, infection rate, kidney injury and mortality rates are comparable with other groups not refusing blood transfusions. In several cases outcome of Jehovah’s Witnesses patients is even better. Treatment of Jehovah’s Witnesses patients has helped the expert community to further develop PBM.
Jehovah’s Witnesses patients are well informed regarding blood conservation techniques. In general, these patients have a clear mind regarding the intervention/surgery and what they accept as treatment options. As mentioned before, the majority knows the problems of anaemia and its potential reversal by preoperative treatment, the use of cell salvage and closed loop systems. Our experience underlines that Jehovah’s Witnesses patients and their families are very cooperative und understanding. It is needless to say that we recommend that physicians accept this group of patients and their beliefs. Especially in view of the recent advancements in medicine, we cannot accept that physicians refuse to provide treatment to Witness patients because of a lack of skill or perhaps a mindset of not wanting to implement PBM. Using all options in PBM, patient safety and outcome is better. Therefore, we use the PBM strategy for all our patients.” (Original in English.)