Jehovah's Witness

Recommendations for adult inpatients who decline some/all blood including Jehovah’s Witness (JW) patients

 

Approved by Transfusion Committee: 20 December 2022

Description: 

Some patients may decline transfusion due to religious (i.e. Jehovah’s Witness) or personal reasons. Under such circumstances, steps should be taken to accurately document the patient’s wishes for transfusion alternatives and appropriately limit the amount of blood taken for phlebotomy.

1. In the situation where a patient declines some or all blood, the patient and/or substitute decision maker should have a discussion about transfusion alternatives with the physician and/or nurse practitioner. The form (see below), Transfusion and Alternative Options as Selected by Patient (PR 15149), should be used to guide the discussion about options for transfusion and alternatives.

   1. Contact the Blood Bank at extension 4051 to obtain this form.

   2. The patient and physician or nurse practitioner should complete this form.

   3. The original white copy should be faxed to the Blood Bank at fax number 4185 and then placed in the patient’s chart.

   4. The yellow copy is given to the patient for their personal records.

   5. Formal documentation of the discussion in the patient’s chart is required, including the patient’s wishes in a situation where blood transfusion may be life-saving.

2. Minimize volume of blood for phlebotomy

   1. Frequency of bloodwork should be minimized.

   2. In addition, small volume sample tubes for CBC, lytes, creatinine can be obtained by contacting Phlebotomy at extension 4007. During off hours, the Blood Bank also carries a set of small volume sample tubes (extension 4051).

3. Additional anemia treatment options should be considered and include:

1. B12 1000 mcg po daily.

2. Folic acid 5 mg po daily.

3. Ferrous gluconate 300mg po daily, if tolerated.

4. In more severe cases of anemia where the hemoglobin is less than 80-90 g/L and the patient declines red blood cell transfusion, consideration should be given to treatment with intravenous iron and erythropoiesis stimulating agents. Hematology consultation is recommended.

 Resources

• Hospital Liaison Committee for Jehovah’s Witnesses
• Sunnybrook Hospital Liaison Committee Members are: Joe Seixas (tel: 416-822-8573) and Michael Hamilton (416-702-2825). Patient permission is required before any specific case discussions. 
• 24 hour hotline: 1-888-501-3103. *This hotline number is made available to Doctors and Clinicians for use when treating, or for questions regarding, Jehovah’s Witness patients only.