Orthopaedic Trauma Management in the Jehovah's Witness Population

Management of acute blood loss anemia in patients who are Jehovah's witness with orthopaedic trauma injuries remains a moral dilemma and medical challenge. There are varying patient beliefs as to what is considered acceptable in the setting of acute blood loss anemia within the Jehovah's Witness community. Advancements have been made in pharmacologic options (iron replacement, erythropoiesis-stimulating agents, tranexamic acid, clotting factors, artificial oxygen carriers) since the time of the religion's blood ban, as well as procedural interventions (interventional radiology, red blood cell salvage). There is minimal published evidence of the acute management of orthopaedic trauma injuries with acute blood loss anemia requiring ongoing orthopaedic surgeries in the Jehovah's Witness population. Management options can be extrapolated from other surgical fields and orthopaedic case reports to create a systematic approach to treatment. Management of patients who refuse blood products with acute blood loss anemia requires a multidisciplinary approach and strict clarification of the patient's beliefs. The goals of this article are to clarify Jehovah's Witness beliefs regarding blood transfusions, review management options available in the orthopaedic trauma setting, and propose a treatment algorithm.