Jehovah's Witnesses

The Jehovah's Witness society is a Christian movement established 140 years ago. It has around 7 million members worldwide who believe that the Bible prohibits the transfusion of blood and its primary components. Some minor components of plasma and clotting factors may be acceptable to some members of the faith. Similarly some will accept intraoperative cell salvage where their own blood from the surgical site can be aspirated and returned to them provided the blood remains within a closed circuit and is never stored. A competent adult may refuse or accept any treatment without giving a reason. These wishes must be respected and followed even if the patient's life is at risk. Senior medical staff must be involved in the care of Jehovah's Witnesses from the outset. They must employ any techniques which will optimize the patient's haemoglobin and minimize blood loss. This ranges from iron and erythropoietin pre- and postoperatively to careful patient positioning and choice of anaesthetic technique to meticulous haemostasis by surgeons. Alternatives to red blood cells remain elusive despite years of research. When faced with lifethreatening haemorrhage these patients are likely to require intensive care to ensure adequate oxygenation, possibly for a prolonged period.