title: The contemporary approach to the care of Jehovah's witnesses.
abstract: BACKGROUND
  Jehovah's Witnesses are widely known for their prohibition on the acceptance of blood transfusion. Such refusal serves as a potential obstacle to optimal therapeutic intervention among critically injured Jehovah's Witnesses. As such, care of these patients requires an aggressive and multidisciplinary approach to therapy.
  
  
  METHODS
  A review of the pertinent English language literature.
  
  
  RESULTS
  Jehovah's Witnesses exercise the right of any adult with capacity to refuse medical treatment and often carry advance directive cards indicating their incontrovertible refusal of blood. Despite their belief regarding transfusion, Jehovah's Witnesses do not have a higher mortality rate after traumatic injury or surgery. Transfusion requirements are often overestimated. Increased morbidity and mortality is rarely observed in patients with a hemoglobin concentration >7 g/dL, and the acute hemoglobin threshold for cardiovascular collapse may be as low as 3 g/dL to 5 g/dL. There are many modalities to treat the Jehovah's Witness patient with acute blood loss. Treatment with recombinant human erythropoietin, albumin, and recombinant activated Factor VIIa have all been used with success. Autologous autotransfusion and isovolemic hemodilution can also be used to treat patients who refuse transfusion. Hemoglobin-based oxygen carriers may play a future role as intravascular volume expanders in lieu of transfusion of red blood cell concentrates.
  
  
  CONCLUSIONS
  There are many treatment modalities available to assist in the care of Jehovah's Witness patients, especially since their beliefs on the intricacies of the Blood Ban appear to be in flux.
authors.affiliation: Department of Surgery, Division of Critical Care and Trauma, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Duncan B
authors.initials: DB
authors.lastname: Hughes
authors.forename: Brant W
authors.initials: BW
authors.lastname: Ullery
authors.forename: Philip S
authors.initials: PS
authors.lastname: Barie
mesh_terms: D001803:Blood Transfusion; D003422:Critical Care; D006401:Hematologic Agents / Q000627:therapeutic use*; D006801:Humans; D033221:Jehovah's Witnesses; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D006401:Hematologic Agents