Lessons learned from transfusion refusal

Jul 10 2012

By Sarah Guy

Jehovah's Witness patients (Witnesses) who refuse blood transfusions during cardiac surgery are not at risk for surgical complications or long-term mortality compared with non-Witnesses who receive transfusions, report US researchers.

Witnesses had fewer postoperative myocardial infarctions, fewer additional operations for bleeding, and a lower hazard for in-hospital death, says the team.

The findings indicate that the severe blood-conserving management strategies used in Witness patients could benefit other patient groups, suggest Colleen Koch (Cleveland Clinic, Ohio) and co-investigators.

"Witnesses hold beliefs that disallow blood product transfusion and therefore offer a natural experiment in severe blood conservation," they explain in the Archives of Internal Medicine, adding that blood conservation practices include preoperative use of erythropoietin, iron, and B-complex vitamins, and intraoperative use of antifibrinolytics.

The study cohort included 322 Witness and 48,986 non-Witness cardiac surgery patients, the latter of whom received transfusions, who were followed up for a respective mean 9.6 and 8.6 years.

The researchers report that the two groups showed similar rates of in-hospital mortality, at 3.1% of Witnesses and 4.5% of non-Witnesses, but Witnesses had significantly lower rates of additional operations for bleeding (3.7 vs 7.3%), myocardial infarction (0.3 vs 2.8%), and prolonged ventilation (6.0 vs 16.0%), than non-Witnesses.

There was a trend toward a lower risk for death/improved survival after 1 year among Witnesses (95% survival vs 89%); however, by 20 years' follow up, mortality rates did not differ significantly from those for non-Witnesses (66 vs 68%).

One important potential limitation of the study is highlighted in an accompanying commentary, by Victor Ferraris (University of Kentucky Chandler Medical Center, Lexington).

"Witnesses who undergo cardiac surgery are likely a healthier subgroup of Witnesses because those who are believed by their surgeons to require blood transfusion to survive cardiac surgery presumably never go to the operating room," he wrote.

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