The Jehovah's Witness patient

Top concerns

1. 1.Individualized consent is everything: allogeneic blood is declined, but positions on cell salvage, albumin, factor concentrates, and continuous-circuit techniques vary person to person — ask, list, document
2. 2.Optimize preop: investigate and treat anemia (iron, B12, EPO per pathway) before elective surgery — the Hb you start with is the buffer
3. 3.Minimize losses everywhere: smallest-volume labs, meticulous surgical hemostasis conversation, antifibrinolytics (TXA), controlled hypotension where appropriate
4. 4.Cell salvage in a continuous circuit and acute normovolemic hemodilution are accepted by many patients — offer explicitly
5. 5.Pediatric cases involve legal/ethical escalation paths — involve the institution early
6. 6.Have the 'what if we're losing' conversation preop, not intraop

Drug do's and don'ts

• PREFERTranexamic acid— Cheap, effective blood conservation — near-default in significant expected loss.
• AVOIDAssuming a universal 'refuses everything' position— Fractionated products and techniques are individual choices — never guess; document specifics.
• AVOIDPreop anemia left unworked-up before elective surgery— The single highest-yield modifiable factor.

Airway & positioning

• No unique airway implications — the discipline is hemostatic and logistical

Pearls

• The best transfusion strategy is the hemoglobin you built preop plus the blood you never lost.
• Documented specifics protect the patient's autonomy AND the team — name products individually.

Suggested reading

• Miller's Anesthesia, 9e (patient blood management)
• AABB / SABM patient blood management resources

Educational quick-reference only — defer to clinical judgment, institutional protocols, and the primary texts above.