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Non-blood products for raising hemoglobin

Posted

Specializes in Oncology. Has 15 years experience.

We have a patient right now who's a Jehovah's Witness with a hgb of 6.0. He obviously won't receive a blood transfusion.

Has anyone ever seen hgb successfully raised, without blood, from a level that low?

He's also still actively bleeding.

Okami_CCRN, ADN, RN

Specializes in Critical Care. Has 4 years experience.

Some non-blood products I have seen to boost Hemoglobin is procrit and ferrlocit (sp). I do not know how well they will work since the patient is still actively bleeding.

From THAT low, raised to something WNL without a transfusion? No. But maybe someone here has.

And still actively bleeding...? Yikes.

Epoetin would take time...

Nothing on the market. The polyheme trial ended early after patient morbidity and mortality increased in patients given polyheme. I understand a bovine hemoglobin product is undergoing trials in South Africa. Hemopure?

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 19 years experience.

Jehovah's Witnesses won't take blood products, so he is taking his own risk. I don't think they will even take synthetic due to the belief they are messing with God's will. The only thing I can think of off hand is Epogen. But I don't know how much it will help if they are actively bleeding

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.

Wow, I had the same situation happen to me one night. I had a patient whose hemoglobin was something like, 6.5. Doc gave an order for type and cross and give 2 units of blood. So I went to inform the lady that she would be receiving blood. She said "I can't take any blood, I'm a Jehovah's Witness." . So, went and called the doc "Um, she's refusing to take the blood"

"Why?"

"She's a Jehovah's Witness"

"You're KIDDING!"

So anyway, he came to the floor and spoke to her, I guess he tried to convince her to take the blood and informed her of the possible consequences if she did not; of course she still refused. We ended up transferring her to a local teaching hospital, where a synthetic blood product was actually being experimented with.

Penelope_Pitstop, BSN, RN

Has 13 years experience.

i don't think they will even take synthetic due to the belief they are messing with god's will.

the belief against blood transfusions isn't about the will of god. it's about cleanliness, ultimately. in the old testament, it was forbidden to have meat with blood in it (like rare steaks, that kind of thing), and jws believe that having the blood put in iv is the same as po. this law was concerning cleanliness, as all the dietary laws of the time were (and for those who do keep kosher, still are).

- jess

NurseyPoo7

Specializes in Acute Care. Has 7 years experience.

Wow, I had the same situation happen to me one night. I had a patient whose hemoglobin was something like, 6.5. Doc gave an order for type and cross and give 2 units of blood. So I went to inform the lady that she would be receiving blood. She said "I can't take any blood, I'm a Jehovah's Witness." . So, went and called the doc "Um, she's refusing to take the blood"

"Why?"

"She's a Jehovah's Witness"

"You're KIDDING!"

So anyway, he came to the floor and spoke to her, I guess he tried to convince her to take the blood and informed her of the possible consequences if she did not; of course she still refused. We ended up transferring her to a local teaching hospital, where a synthetic blood product was actually being experimented with.

Isnt the doctor supposed to get a blood consent signed by the pt before they order prbcs?

IngyRN

Specializes in Med/Surg, Homecare, UR, Case Mgt. Has 10 years experience.

Isnt the doctor supposed to get a blood consent signed by the pt before they order prbcs?

Good point. But the answer is no. This is according to hospital policy & procedure. At my hospital the RN gets consent.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Isnt the doctor supposed to get a blood consent signed by the pt before they order prbcs?

At our hospital docs can order it all they want, but the blood bank won't release the blood without a current T&S and consent.

RNAnnjeh, MSN, CNS

Specializes in Pedatrics, Child Protection. Has 18 years experience.

Would factor (can't remember the #---?8) be considered a blood product? If not, it may help with the active bleeding. Have only ever given Epogen in that situation, and no, it didn't help.

Jehovah's Witnesses won't take blood products, so he is taking his own risk. I don't think they will even take synthetic due to the belief they are messing with God's will. The only thing I can think of off hand is Epogen. But I don't know how much it will help if they are actively bleeding

Actually, according to Watchtower Magazine, they are very strong proponents of finding alternative/synthetic blood products.

Their issue is that they feel the bible tells them not to consume blood, that it is an abomination. So, blood transfusions are right out. That doesn't mean that they don't want treatment, just that they feel that the available options are forbidden.

BigT

Specializes in ICU, Dialysis. Has 5+ years experience.

the belief against blood transfusions isn't about the will of god. it's about cleanliness, ultimately. in the old testament, it was forbidden to have meat with blood in it (like rare steaks, that kind of thing), and jws believe that having the blood put in iv is the same as po. this law was concerning cleanliness, as all the dietary laws of the time were (and for those who do keep kosher, still are).

- jess

actually refusing blood transfusions is about following the will of god. god held blood as sacred since the life of a person was in the blood. leviticus 17:11-"for the soul of the flesh is in the blood, and i myself have put it upon the altar for you to make atonement for your souls, because it is the blood that makes atonement by the soul [in it]. "

later on the refusing to partake of blood products was reaffirmed to christians as well at (acts 15:28-29) . . ".for the holy spirit and we ourselves have favored adding no further burden to you, except these necessary things, 29 to keep abstaining from things sacrificed to idols and from blood and from things strangled and from fornication. if you carefully keep yourselves from these things, you will prosper. good health to you!"

so it is about following god's wishes and staying morally clean by following god's will.

to help the op, there is a website that has some strategies to help a patient that declines blood transfusions. it is a jehovahs' witness site so the information will be reliable and not speculation.

http://www.watchtower.org/e/medical_care_and_blood.htm

and here is another resource that has some info and studies posted. it is not a official jehovah's witness site even though the topics are relevant.

http://www.noblood.org/

hope that helps all some.

t

Penelope_Pitstop, BSN, RN

Has 13 years experience.

so it is about following god's wishes and staying morally clean by following god's will.

thanks for correcting me. however, the post i was replying to stated that synthetic products would be tampering with the will of god.

~jess

BigT

Specializes in ICU, Dialysis. Has 5+ years experience.

thanks for correcting me. however, the post i was replying to stated that synthetic products would be tampering with the will of god.

~jess

jess,

using synthetic blood products is permissable. jehovah's witnesses do not believe that there is a specific god ordained will for a person to die or live. so life saving measures are universally employed with the exception of whole blood or red cells,white cells, plasma or platelets. the patient should have a signed medical directive on them that is a legally binding explaination of their wishes. that should help clarify what the patients wishes are.

because of the stand that jehovah's witnesses hold with regard to declining blood transfusions- many new and minimally invasive surgeries and treatments are being invented and used on the patient population as a whole that is benefitting the entire health care industry.

if you take a few minutes to look at the above sites, it might amaze you how the medical industry has met the challenge of bloodless medical interventions and as a result have found alternatives that surpass the traditional medical procedure in terms of successful patient outcomes and overall recovery times.

t

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Please, BigT, what advances are going to help this patient? I'd really like to know if there's a way we can "meet this challenge." Please feel free to share what "alternative" there is that "surpasses traditional treatment" for this man.

It is a mute point. What synthetic blood product is available for use? Polyheme? The study was ended early because it looked like people were dying from the polyheme instead of the trauma. What does that leave us with. Hespan, dextran, hypertonic saline? Great if I want to pull fluid into the vascular space. Not really helpful in restoring the ability to transport oxygen and have platelets and clotting factors available.

All of the religious interpretation is really neat; however, it is all academic at this point. We simply do not have a synthetic product that can function effectively as a blood substitute.

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