A Jehovah's Witness with complex abdominal trauma and coagulopathy: use of factor VII and a review of the literature.
Management of acute bleeding in patients who are Jehovah's Witnesses remains a challenge. Clearly, the most important concept is meticulous and early hemostasis to minimize ongoing blood loss. This is generally followed by supportive measures. Dilutional coagulopathy can present a real challenge, as therapeutic options are quite limited in this group of patients. We present a patient who arrived in hemorrhagic shock, and despite early surgical therapy, his significant blood loss caused dilutional coagulopathy that we treated with activated factor VIIa. While use of factor VIIa after injury is gaining popularity, data on its use in patients who are Jehovah's Witnesses is quite limited. In this case, we believe the product was life-saving. Most importantly, there were no religious objections to its use. In appropriate patients, when surgical bleeding is controlled and there is still evidence of dilutional coagulopathy, factor VIIa may have a real role in patients, particularly those who are Jehovah's Witnesses.
Department of Surgery, Critical Care, University of Maryland Medical System, Baltimore, Maryland 21201, USA.
James
J
Haan
Thomas
T
Scalea
D000007:Abdominal Injuries / Q000150:complications / Q000628:therapy*; D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy*; D005167:Factor VII / Q000627:therapeutic use*; D005440:Fluid Therapy / Q000009:adverse effects; D006488:Hemostasis, Surgical; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D010342:Patient Acceptance of Health Care; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy*; D013514:Surgical Procedures, Operative; D016312:Treatment Refusal
D006490:Hemostatics; D005167:Factor VII