title: How to approach major surgery where patients refuse blood transfusion (including Jehovah's Witnesses).
abstract: Jehovah's Witnesses do not permit the use of allogeneic blood products. An increasing number of patients are refusing blood transfusion for non-religious reasons. In addition, blood stores are decreasing, and costs are increasing. Transfusion avoidance strategies are, therefore, desirable. Bloodless surgery refers to the co-ordinated peri-operative care of patients aiming to avoid blood transfusion, and improve patient outcomes. These principles are likely to gain popularity, and become standard practice for all patients. This review offers a practical approach to the surgical management of Jehovah's Witnesses, and an introduction to the principles of bloodless surgery that can be applied to the management of all patients.
authors.affiliation: Department of Vascular Surgery, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK.
authors.forename: M S
authors.initials: MS
authors.lastname: Gohel
authors.forename: R A
authors.initials: RA
authors.lastname: Bulbulia
authors.forename: F J
authors.initials: FJ
authors.lastname: Slim
authors.forename: K R
authors.initials: KR
authors.lastname: Poskitt
authors.forename: M R
authors.initials: MR
authors.lastname: Whyman
mesh_terms: D016223:Advance Directives; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000379:methods*; D006410:Hematopoiesis; D006438:Hemodilution; D006801:Humans; D007258:Informed Consent; D007430:Intraoperative Care / Q000379:methods; D033221:Jehovah's Witnesses; D013514:Surgical Procedures, Operative / Q000379:methods*; D016312:Treatment Refusal