Patient (condition)
 
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Ensure a thorough discussion is had with the patient privately. Provide adequate information on risks and benefits of the use of blood products, and assess the capacity and voluntary nature of any decisions.

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Example of well planned and managed cesarian section in Jehovah's witness patient with placenta percreta. refl.in/b0

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Optimise preoperative hemaglobin. Treat iron deficiency. Consider erythropoetin. Discuss options with hematologist.

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Make no assumptions about the patient's willingness to accept blood products based on their identification as a Jehovah's Witness. Discuss with the patient or find the patient's advanced directive.

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If no contraindications to cell saver/salvage (cancer, infecton etc) discuss its suitability with surgeon and patient.

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Most patients will refuse "primary components" of blood (PRBC, Platelets, Plasma), but will differ on acceptance of secondary components. Ensure preferences are documented refl.in/8a

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In 2000, Watchtower defined the “primary components” of blood as
red & white cells, plasma & platelets. Individuals can now decide for themselves whether to
accept fractions of these refl.in/8a

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Good summary of approach and issues - Office of the Public Advocate. Guidelines and Policy, Victoria, Australia refl.in/89

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3
Patient may have an advanced directive with detailed instructions on use of blood products.

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Two medical practitioners are able transfuse a child against their parent's wishes if it "constitutes reasonable and proper treatment"
according to Section 24 of The Human Tissue Act 1982 VIC Australia refl.in/8b

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In the year 2000, the church of Jehovah's witnesses modified its policy wording from a process of "Disfellowship" to one of "Dissociation" in the event a member has received a transfusion. This shift in wording means that the patient now chooses whether to reveal transfusions to their church, rather than be questioned by the church in the event of their hospitalisation. refl.in/8a

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