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Blood Transfusion and Children of Jehovah's Witnesses

What are the chances that my child may need a blood transfusion during surgery?

The likelihood of needing a blood transfusion is very small, if your child is otherwise healthy and it is a simple operation. The chances increase if your child is severely anemic or having complex surgery, such as heart surgery. Most surgeries performed in children result in very little blood loss. However, your child may receive a balanced salt solution also known as "crystalloid" through an IV to make up for the lack of drinking prior to the operation and for replacing fluid and minor blood losses during the operation. Crystalloids contain no human or animal tissue.

How would a blood transfusion, if needed, help my child?

A blood transfusion helps to provide enough red blood cells to carry oxygen throughout the body. Without an adequate amount of red blood cells, the body may become starved for oxygen, which if left untreated can have life threatening consequences, such as brain or heart damage. Other components found in blood include coagulation factors, which are needed for clot formation to stop bleeding. It may be necessary to transfuse these coagulation factors during and/or after the operation to help reduce the loss of red blood cells. Lastly, in some cases, colloids, such as 5% albumin, which represent the protein component of blood, may also be used to help increase the blood volume.

Are there ways to minimize or prevent a need for blood transfusion?

There are several ways that may help reduce the chance that your child may require a blood transfusion. One method is to increase the production of red blood cells prior to the operation by supplementing your child's diet with iron or the administration of recombinant human erythropoietin. In addition, the anesthesiologist may use techniques to conserve red blood cells referred to as acute normovolemic hemodilution or controlled hypotension. Acute normovolemic hemodilution involves withdrawing and storing your child's blood outside of the body, while still remaining in contact with the body. The amount of blood removed is replaced with IV crystalloid. Your child's own stored blood that contains both red blood cells and clotting factors is transfused when the surgery is near completion. Another technique is to lower the blood pressure to a safe, predetermined value, which theoretically reduces the amount of bleeding at the operative site. Another common technique is to suction blood from the surgery site using a machine called a cell saver. This machine scavenges and filters your child's blood making it safe for transfusion. Your child receives back his/her own blood at or near the completion of surgery. Also, in selected cases, the anesthesiologist may choose to administer medications during the operation to help improve your child's ability to form blood clots.

We are Jehovah's Witnesses and do not accept blood. Can we be assured that our child will not be given any blood products during surgery?

Every effort will be made to avoid a blood transfusion, however in life-threatening situations involving severe anemia or bleeding, the anesthesia team is obligated to follow federal and state guidelines for the care of minors. While regulations vary from state to state, and from institution to institution, children under the age of 18 generally cannot be denied a blood transfusion when it is considered a life saving therapy. In other words, parents who are Jehovah's Witnesses must understand that their children may receive blood and blood products based on their medical condition and ongoing blood loss during an operation. However, parents can help reduce the chances of their child receiving a blood transfusion by improving or increasing the red cell count in their child's body and discussing with the anesthesiologist ways in which to conserve red blood cells and improve clotting function.

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