Management strategies for perioperative anaemia in the severely burn-injured Jehovah’s Witness patients who decline a blood transfusion
Mia Jung1, Varun Harish1, Aruna Wijewardena1, Ian Kerridge2, Rowan Gillies1, 1Department of Burns, Plastic and Maxillofacial Surgery, Royal North Shore Hospital, Sydney, NSW, Australia2Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
Abstract
Background: The management of severe burn-injured Jehovah’s Witness patients who decline a blood transfusion poses unique challenges. There is a paucity of literature guiding perioperative anaemia management in these patients. We present a systematic review of this patient group, along with illustrative, consecutive case reports of our experience.
Methods: A systematic review was performed on Embase, MEDLINE and PubMed databases on articles discussing the treatment of burn-injured Jehovah’s witness patients. Articles were excluded if discussing isolated inhalation injury, or if blood transfusions were permitted.
Results: 9 articles including a total of 11 patients revealed consistent themes. A multimodal medical and surgical approach is suggested. Medical strategies are directed at reducing blood loss and optimising haematopoiesis and include rationalising blood collection, reversing coagulopathy, administering tranexamic acid and regular erythropoietin. Surgical strategies include staged aggressive debridement, tumescent adrenaline infiltration and limb tourniquets. We found that the argon beam coagulator was an effective haemostatic adjunct not previously described in literature.
Discussion: Management of anaemia in severely burn-injured Jehovah’s witness patients is challenging. This systematic review presents a summary of strategies directed at minimising blood loss, and optimising haematopoiesis. Careful preoperative planning, meticulous surgical technique, and postoperative physiological support are caveats to success.
Biography
Dr Jung is a plastic surgery registrar from Sydney NSW Australia. She worked in the Plastics & Burns Surgery Department at Royal North Shore Hospital in 2020