MONDAY, July 2 (HealthDay News) — Jehovah’s Witnesses routinely
refuse blood transfusions, and new research suggests the religious custom
has some benefits, at least when it comes to heart surgery.
The study of cardiac surgery patients found that the risk of dying was
similar among 322 members of the Jehovah’s Witness religion, who did not
receive blood transfusions, and 322 patients who did get transfusions.
Moreover, the Jehovah’s Witness patients had lower risks of additional
surgeries, heart attack, kidney failure and blood infection than the
others, according to the report published online July 2 in Archives of
Internal Medicine.
“These practices that are done for Jehovah’s Witnesses do not put them
at risk for complications,” said study author Dr. Colleen Koch, a
cardiothoracic anesthesiologist at Cleveland Clinic in Ohio.
The Jehovah’s Witness patients also spent less time in the intensive
care unit and less time in the hospital overall than the transfused
patients. However, 20-year survival was similar in both groups.
The findings may have implications outside of this specific population,
which presented an opportunity for a “natural experiment,” the authors
said. “It behooves us to examine more closely some Jehovah Witness
processes of care and implement them in our routine surgeries,” Koch
said.
The Jehovah’s Witness practice of refusing blood transfusions stems
from a belief that the Bible forbids ingesting blood.
Although screening techniques introduced in the 1990s ensure the blood
supply is safer today than it used to be, blood transfusions still confer
some risks. These must be balanced against the risks associated with
anemia, a condition characterized by low levels of healthy red blood
cells, which is the reason for transfusion. Anemia can cause severe
fatigue and dizziness.
The standard on when to transfuse is based on expert opinion and varies
by hospital and surgeon, Koch said. “There is no number for how low you
can go in terms of anemia before ordering a blood transfusion,” she
said.
Concerns about U.S. blood-supply shortages has sired a movement to curb
unnecessary transfusions. And, as more aging baby boomers undergo
surgeries, they’re likely to further strain the blood supply, Koch said.
“We need to determine if there is anything we can do to decrease the need
for blood without increased risk for complications,” she said.
The authors noted that Jehovah’s Witness patients follow blood
conservation practices intended to avoid extreme anemia, including
preoperative use of the hormone erythropoietin, iron and B complex
vitamins.
Experts welcomed the report.
Dr. Gregory Fontana, chairman of cardiothoracic surgery at Lenox Hill
Hospital in New York City, called the new study “a spectacular
contribution.”
But, “just because this paper is published, we cannot willy nilly start
treating everyone like Jehovah’s Witnesses,” he said. “It does provide
further evidence that transfusion with real indication carries a risk that
heretofore has been underestimated.”
Surgeons are taught to transfuse “reflexively” when anemia dips below a
certain level, he explained. “This is too simplistic. We need to take a
careful, careful look at a growing body of evidence that transfusion and
use of blood-transfusion products should be taken very seriously and only
occur with clear, clear indication.”
Dr. Victor Ferraris, a professor of vascular surgery at the University
of Kentucky Chandler Medical Center in Lexington, agreed in an
accompanying journal editorial. “The findings of this analysis . . . add
to the increasing data that suggest that more conservative use of blood
transfusions would be in our patients’ interest, in both Witnesses and
non-Witnesses,” Ferraris wrote.
More information
Learn about blood transfusions at the U.S. National Heart, Lung, and Blood
Institute.
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