title: Right hemicolectomy in a severely anemic Jehovah's Witness patient with an extremely low preoperative hemoglobin level and the decision to operate.
abstract: Severe anemia is associated with high mortality, and patients with this condition are typically treated with packed blood red cells. Patients of Jehovah's Witness faith, however, do not accept blood transfusion therapy. The authors report the case of a Jehovah's Witness patient who presented with lower gastrointestinal bleeding secondary to Clostridium difficile colitis. Because the patient refused blood transfusion therapy, he underwent a right hemicolectomy with a preoperative hemoglobin level of 2.7 g/dL and a postoperative hemoglobin level of 1.8 g/dL. He was neurologically intact and discharged to a skilled care facility on postoperative day 10. The surgical team worked with the patient, his family, the anesthesiologists, and the Jehovah's Witness Hospital Liaison Committee physician members to devise a care plan that fully supported and respected the patient's religious beliefs and allowed him to maintain complete autonomy in his treatment decisions. Health care providers should be aware of how a patient's ethical, cultural, and religious background may impact treatment options.
authors.affiliation: From Mercy St. Vincent Medical Center in Toledo, Ohio.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Yeykal
authors.affiliation: From Mercy St. Vincent Medical Center in Toledo, Ohio julie_stausmire@mercy.com.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Stausmire
authors.affiliation: From Mercy St. Vincent Medical Center in Toledo, Ohio.
authors.forename: Mohammed Y
authors.initials: MY
authors.lastname: Ahmed
authors.affiliation: From Mercy St. Vincent Medical Center in Toledo, Ohio.
authors.forename: Ajith
authors.initials: A
authors.lastname: Pai
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology / Q000601:surgery*; D003015:Clostridium Infections / Q000150:complications; D003082:Colectomy / Q000379:methods*; D003092:Colitis / Q000150:complications / Q000382:microbiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male
chemical_list: D006454:Hemoglobins