Importance Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the literature about management of Jehovah's Witness patients in obstetrics and gynecology, most of them are case reports, and a comprehensive review about these patients including ethicolegal perspective is lacking. Objective This review outlines the medical, ethical, and legal implications of management of Jehovah's Witness patients in obstetrical and gynecological settings. Evidence Acquisition A search of published literature using PubMed, Ovid Medline, EMBASE, and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion, and ethical/legal considerations in Jehovah's Witness patients. Results Early diagnosis of anemia and immediate initiation of therapy are essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as antihepcidin antibodies and hemoglobin-based oxygen carriers. Options to decrease blood loss include antifibrinolytics, desmopressin, recombinant factor VII, and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches. Conclusion and Relevance All obstetricians and gynecologists should be familiar with alternatives and "less invasive" options for patients who refuse blood transfusions. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this activity, the learner should be better able to explain the oxygen delivery systems and response to tissue hypoxia mechanisms in humans, recognize options to correct anemia in Jehovah's Witness patients, recognize agents that are used in certain clinical scenarios in obstetrics and gynecology setting to reduce blood loss in patients who are refusing blood transfusion, and identify ethical/legal considerations for Jehovah's Witness patients.
ASJC Scopus subject areas
- Obstetrics and Gynecology