10. Managing transfusion locally

Key points

• Some patients (Jehovah's Witnesses, for example) refuse blood transfusions due to their religious convictions.
• It will be extremely difficult for the surgical and anaesthetic teams to do major surgery without using blood. Patients who refuse blood or blood products should be informed of all of their options.
• Avoid unnecessary large volume blood samples
• Plan optimal anaesthetic approach
• Consider cell salvage if feasible/appropriate
• Consider surgical options aimed at minimising blood loss
• Optimise patients prior to surgery (anaemia management)

Rationale

A thorough Health Care Advance Directive (Living Will) is frequently executed by JW, and many of them carry an "advance directive" that forbids blood transfusions. 

Links to resources (where available)

Jehovah’s Witnesses and blood transfusion (JPAC UK)

Transfusion Replacement Strategies in Jehovah’s Witnesses

Key points

• Blood supply issues – risk of blood shortages
• Plan contingency local guidelines – staff/product 
• Priority/patient  priority

Rationale

During prolonged extreme shortages, blood centres and transfusion services must alter practices to meet the needs of patients. [refer to local guidelines where available]

Links to resources (where available)

Blood shortages (NHS)

How do I manage blood product shortages

Key points

Patient blood management 
• Evidence-based, multidisciplinary approach to caring for patients who might need a blood transfusion
• Encompasses all aspects of the transfusion decision-making process, beginning with the initial patient evaluation and continuing through clinical management. 
• Aim is for optimal patient outcomes, while maintaining the blood supply to guarantee that blood components are available for patients when they are needed.

Rationale

For the learner to better understand both the decision to transfuse and the alternatives (where available locally).

The urgent need to implement patient blood management: policy brief (who.int)

Patient Blood Management (aabb.org)

BloodSafe eLearning Australia (bloodsafelearning.org.au)

Patient Blood Management Guidelines | National Blood Authority