Blood Management Strategies in Primary and Revision Total Knee Arthroplasty for Jehovah's Witness Patients

Abstract

Primary or revision total knee arthroplasties (TKAs) may be associated with a marked amount of intraoperative or postoperative blood loss that potentially may lead to the need for blood transfusions. However, Jehovah's Witnesses usually refuse blood transfusions because of their religious beliefs. This may create clinical or ethical challenges for the treating physicians. Therefore, following established blood management protocols specifically designed for these patients may be beneficial for the performance of safe and transfusion-free procedures with minimal complications. In this report, we provide an overview of various potential preoperative, intraoperative, and postoperative blood management measures that may be used for the care of Jehovah's Witnesses who undergo knee arthroplasty procedures. In addition, we review reported outcomes of primary and revision TKAs in these patients.

Keywords

total knee arthroplasty - blood management

• References

• 1 Janis L, Krawetz L, Wagner S. Ankle and subtalar fusion utilizing a tricortical bone graft, bone stimulator, and external fixator after avascular necrosis of the talus. J Foot Ankle Surg 1996; 35 (2) 120-126 , discussion 188–189
• 2 Statistics. Report of Jehovah's Witnesses Worldwide. Available at: http://www.watchtower.org/e/statistics/worldwide_report.htm . Accessed February 18, 2013
• 3 Laskin RS. Minimizing blood loss after total knee replacement. Orthopedics 2004; 27 (9) 981-982
• 4 Sinclair KC, Clarke HD, Noble BN. Blood management in total knee arthroplasty: a comparison of techniques. Orthopedics 2009; 32 (1) 19
• 5 Rogers DM, Crookston KP. The approach to the patient who refuses blood transfusion. Transfusion 2006; 46 (9) 1471-1477
• 6 Partovi S, Bruckner BA, Staub D , et al. Bloodless lung transplantation in Jehovah's Witnesses: impact on perioperative parameters and outcome compared with a matched control group. Transplant Proc 2013; 45 (1) 335-341
• 7 Lorentzen K, Kjær B, Jørgensen J. Supportive treatment of severe anaemia in a Jehovah's Witness with severe trauma. Blood Transfus 2013; 11 (3) 452-453
• 8 Beliaev AM. High-risk anaemic Jehovah's Witness patients should be managed in the intensive care unit. Blood Transfus 2013; 11 (3) 330-332
• 9 Graffeo C, Dishong W. Severe blood loss anemia in a Jehovah's Witness treated with adjunctive hyperbaric oxygen therapy. Am J Emerg Med 2013; 31 (4) e3-e4
• 10 Harwin SF, Pivec R, Johnson AJ, Naziri Q, Mont MA. Revision total hip arthroplasty in Jehovah's Witnesses. Orthopedics 2012; 35 (8) e1145-e1151
• 11 Angouras DC. Jehovah's Witnesses may not have identical outcomes with nontransfused non-witnesses after cardiac surgery. JAMA Intern Med 2013; 173 (3) 248-249
• 12 Bowen JR, Angus PD, Huxster RR, MacEwen GD. Posterior spinal fusion without blood replacement in Jehovah's Witnesses. Clin Orthop Relat Res 1985; (198) 284-288
• 13 Siddiqui FM, Slater RM, Razzaq I, Atkinson M, Ryan K. Tourniquet use during total knee replacement in a Jehovah's Witness with sickle cell trait: a case report. Eur J Anaesthesiol 2010; 27 (6) 581-582
• 14 Harwin SF, Issa K, Naziri Q, Pivec R, Johnson AJ, Mont MA. Excellent Results of Revision TKA in Jehovah's Witness Patients. J Knee Surg 2013; 26 (3) 151-154
• 15 Harwin SF, Issa K, Naziri Q, Johnson AJ, Mont MA. Results of primary total knee arthroplasty in Jehovah's Witness patients. J Arthroplasty 2013; 28 (1) 49-55
• 16 Mariorenzi AL, Pierik MG. Quadruple major joint replacement in member of Jehovah's Witnesses. No blood products, autotransfusion or substitutes used. Orthop Rev 1986; 15 (8) 531-533
• 17 Cooper L, Ford K, Miller E. Preparing a Jehovah's Witness for major elective surgery. BMJ 2013; 346: f1588
• 18 Alcelik I, Pollock RD, Sukeik M, Bettany-Saltikov J, Armstrong PM, Fismer P. A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 2012; 27 (3) 331-340
• 19 Tai TW, Chang CW, Lai KA, Lin CJ, Yang CY. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 2012; 94 (24) 2209-2215
• 20 Harvey EJ, Leclerc J, Brooks CE, Burke DL. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty 1997; 12 (3) 291-296
• 21 Messmer K. Hemodilution—possibilities and safety aspects. Acta Anaesthesiol Scand Suppl 1988; 89: 49-53
• 22 Zohar E, Fredman B, Ellis M, Luban I, Stern A, Jedeikin R. A comparative study of the postoperative allogeneic blood-sparing effect of tranexamic acid versus acute normovolemic hemodilution after total knee replacement. Anesth Analg 1999; 89 (6) 1382-1387
• 23 Eroglu A, Uzunlar H, Erciyes N. Comparison of hypotensive epidural anesthesia and hypotensive total intravenous anesthesia on intraoperative blood loss during total hip replacement. J Clin Anesth 2005; 17 (6) 420-425
• 24 Liguori GA, Sharrock NE. Asystole and severe bradycardia during epidural anesthesia in orthopedic patients. Anesthesiology 1997; 86 (1) 250-257
• 25 Hughes DB, Ullery BW, Barie PS. The contemporary approach to the care of Jehovah's witnesses. J Trauma 2008; 65 (1) 237-247
• 26 Berend K, Levi M. Management of adult Jehovah's Witness patients with acute bleeding. Am J Med 2009; 122 (12) 1071-1076
• 27 Panousis K, Rana B, Hunter J, Grigoris P. Rapid sequence quadruple joint replacement in a rheumatoid Jehovah's Witness. Arch Orthop Trauma Surg 2003; 123 (2-3) 128-131