Non-blood products for raising hemoglobin

correctlywrong · Sep 4, 2008

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 · Sep 4, 2008

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 · Sep 4, 2008

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 · Sep 4, 2008

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 · Sep 4, 2008

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.

GilaRRT · Sep 4, 2008

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.

Penelope_Pitstop, BSN, RN · Sep 4, 2008

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

which is exactly what i was saying...

-jess

smk1, LPN · Sep 4, 2008

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

Check your BON because this policy may be against the law. Blood is still and informed consent procedure and in my state requires the provider to explain the procedure and risks and obtain consent. People were getting lax about this policy in my area and we had a timely reminder about the legalities of it. In any case, the bloodless medicine centers are great resources. EPO would take time to work and if you haven't stopped the bleed anyway is not going to do a whole lot.

BigT · Sep 5, 2008

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.

Blondy,

First off I do not pretend to be an expert on the matter. But some things to help this man might be the following:

1. Obviously the first thing is to limit the blood loss. Not knowing the nature of the injury, some of the suggestions may or may not have merit.

Making sure that the clotting factors are in order and perhaps being able to supplement that route may be an option.

1b. In line with conservation of blood loss- using microsampling techniques such as is used on premmies. Much blood can be lost to periodic blood sampling using the test tubes, whereas using the pipette type blood tubes, any unnecessary blood loss is eliminated for any necessary blood testing.

1c. if the blood loss is in a mobile part of the body, simply lifting that area of the body above the heart can lower the blood pressure in that area resulting in less blood flow out of the wound. Often times the lowering of the blood pressure in the affected area can allow the clotting factors to do their job and solve the blood loss- depending on the type of vascular damage.

2. Obviously the main job of blood is to carry oxygen to the body. Another medical intervention that can help with that purpose is a hyperbaric chamber. By hyperoxygenating the blood, the blood works most efficiently in carrying it to the various body parts. Less blood is needed to do the same job.

3. Another possible thing to look at is EPO. Many people feel that EPO is only a long term blood builder, but several cases show otherwise. Starting at a high initial dose (367U/kg of body weight/day), and keeping that dose high while realizing that the EPO half life is 12-17 hours, has often produced results in as short as one day with concrete 2-3 g/dl results after 3.

3b. To initiate a sudden rise in red blood cells, having above normal levels of iron, folic acid and vitamin b12 are necessary. Having a shortage of any one of these can limit the bodies ability to produce red blood cells, especially after chronic bleeding. Supplementing a bioavailable form of these supplements speeds this process.

3c. When rapid red blood cell production is initiated, a clinician will want to pay very close attention to blood pressure as often the rapid increase in blood cells will thicken the blood up and additional fluids may be needed to thin it back down and improve overall circulation of the blood.

4. Depending on the patients conscience and injury, a cellsaver machine might be used to clean and re-use the patients own blood- if it is still within the body, if it viewed by the patient that the machine is an extension of his own cirulatory system.

These are just a few ideas, and I am sorry that I don't know more details or that I am not better versed in this particular emergency. I hope they may provide some benefit for your patient.

T

BigT · Sep 5, 2008

which is exactly what i was saying...
-jess

jess,

i am sorry if i came across harsh or not very understandable. you had the right answer, but some of the reasoning behind it was slightly off, so i was attempting to try and correct that. i apologize if my post was misunderstood by you or if i gave you the wrong impression. thanks for offering the correct answer to the other poster.

t

Penelope_Pitstop, BSN, RN · Sep 5, 2008

jess,
i am sorry if i came across harsh or not very understandable. you had the right answer, but some of the reasoning behind it was slightly off, so i was attempting to try and correct that. i apologize if my post was misunderstood by you or if i gave you the wrong impression. thanks for offering the correct answer to the other poster.
t

sounds like we misunderstood each other. ah, the joys of online communication! :)

anyway, the issue concerning who obtains blood consent...i always obtained it myself, with a witness. i would provide the patient with a detailed piece of literature concerning blood transfusions, and if the patient had any concerns, i would not obtain the consent without making sure the physician had described the procedure. the reason why i could obtain it myself? i'm the transfusionist...the physician is not.

jess

blondy2061h, MSN, RN · Sep 5, 2008

BigT, those would all be good ideas, except, he has leukemia. He's experiencing myelosuppression to the max. His blood can't clot. He can't make appropriate red blood cells, etc, etc.

He's in ICU on a vent now.