Emergency Situations
It is now considered relatively common to carry out uncomplicated
elective cardiac surgery on Witnesses, as this enables meticulous
planning and execution of blood management strategies. However,
emergency cardiac surgery does not allow for careful planning,
presenting a greater challenge and thus increasing the risk of bleeding
both peri- and post- operatively. Under such circumstances the doctor
has a legal right to determine whether to proceed with a blood
transfusion if they cannot clearly ascertain the refusal of blood
products5. Emergency cardiac surgery in witnesses
presents additional problems; presentation with severe anaemia and
bleeding is inherently difficult to manage without the transfusion of
blood. Research by Viele and Weiskopf found Witnesses that did not
receive transfusions, 50 mortalities occurred due to anaemia, with a
haemoglobin of ≤8 g/dl or a haematocrit of ≤24%60.
This has since been supported by Hogervorst et al . who
highlighted an association between low haemoglobin levels
(<8g/dl) and levels of mortality and
morbidity55. Contrary to this, a study carried out
over a ten year period on 91 Witnesses undergoing cardiac surgery, found
no significant difference in the risk of mortality or major
complications between those who received emergency compared to elective
surgery52. The differences in outcomes between Witness
and non-Witness patients in the clinical literature is important to
explore in order to ascertain the impact of refusal of blood and blood
products on these patients.