Jehovah’s Witness heart patients do well, even without transfusions
Published Tuesday, July 3, 2012 2:51PM EDT
Last Updated Tuesday, July 3, 2012 3:00PM EDT
Jehovah’s Witnesses who have heart surgery don’t seem to fare any worse than other patients, even though they refuse to undergo blood transfusions during the surgery, a new study has found.
Jehovah’s Witnesses believe that passages in the Bible bar them from accepting the blood of others, including blood donated to replace what they might lose in surgery.
Instead of blood, they take supplements to boost their blood production ahead of surgery and ask their doctors to use certain techniques and medications during surgery that can minimize blood loss.
To see how Jehovah’s Witness patients fared following heart surgery, a team from the Cleveland Clinic in Ohio conducted a study of their long-term survival.
They compared 322 Jehovah’s Witness heart surgery patients with almost 49,000 non-Witnesses who had blood transfusions during heart surgery between 1983 to 2011.
The researchers found the Jehovah’s Witnesses had the same risk of dying while in hospital as non-Witnesses.
But, the Witnesses had lower chances of needing further operations for bleeding compared to patients who received transfusions. They also had a lower risk of kidney failure and sepsis.
Witnesses also had shorter hospital lengths of stay compared with matched patients who received transfusions, as well as shorter intensive care unit lengths of stay.
One year after the surgery, Witnesses had higher survival rates compared with non-Witnesses: 95 per cent vs. 89 per cent. But both groups had similar 20-year survival rates (34 per cent vs. 32 per cent).
The results appear in Archives of Internal Medicine.
Jehovah’s Witnesses are encouraged to use “blood conservation practices” instead of transfusions to ward off the anemia that can come from severe blood loss.
They sometimes take iron and B-complex vitamins ahead of the surgery to boost their red blood cell count, as well as erythropoietin, a hormone used in the formation of red blood cells. (It’s also called EPO when used for doping among athletes.)
They also take medications to reduce blood loss during surgery, called antifibrinolytics.
The study authors say that Jehovah's Witnesses provide a unique “natural experiment” to test blood conservation techniques.
They write that while some of these techniques carry risks, so do blood transfusions, including allergic reactions, and “acute immune hemolytic reaction” that can occur when the wrong blood type is transfused by mistake.
In an accompanying editorial, surgeon Dr. Victor Ferraris points out that it's possible that Jehovah’s Witnesses who undergo heart surgery without transfusions are healthier that typical heart patients. That’s because a Witness with complicated heart needs likely wouldn’t be operated on if his or her doctor wouldn’t want to risk surgery without a transfusion.
Nevertheless, “the finding that the Witnesses who did not receive transfusions did at least as well as, if not better than, those who received a transfusion raises questions about whether more patients might benefit from surgical strategies that minimize transfusion of blood products," Ferraris said.