Management strategies for perioperative anaemia in the severely burn-injured Jehovah?s Witness patients who decline a blood transfusion: A systematic review with illustrative case reports

Background: The management of severe burn-injured Jehovah's Witness patients who de-cline a blood transfusion poses unique challenges. The literature is scant for guiding perioperative anaemia management in these patients. We present a systematic review of this patient group, along with illustrative, consecutive case reports of our experience.Methods: A systematic review was performed on Embase, MEDLINE and PubMed databases on articles discussing the treatment of burn-injured Jehovah's Witness patients. Articles were excluded if discussing isolated inhalation injury, or if blood transfusions were permitted.Results: Nine articles including a total of 11 patients revealed consistent themes. A mul-timodal medical and surgical approach is suggested. Medical strategies are directed at reducing blood loss and optimising haematopoiesis and include rationalising blood col-lection, reversing coagulopathy, administering tranexamic acid and regular erythropoietin. Surgical strategies include staged aggressive debridement, tumescent adrenaline infiltra-tion and limb tourniquets. We found that the argon beam coagulator was an effective haemostatic adjunct not previously described in literature. Discussion: Management of anaemia in severely burn-injured Jehovah's Witness patients is challenging. This systematic review presents a summary of strategies directed at mini-mising blood loss, and optimising haematopoiesis. Careful preoperative planning, meti-culous surgical technique, and postoperative physiological support are caveats to success.(c) 2022 Elsevier Ltd and ISBI. All rights reserved.

Automated summary

This article provides a systematic review of the management of severe burn-injured Jehovah's Witness patients who decline blood transfusions. The review suggests medical and surgical strategies to reduce blood loss and optimize hematopoiesis.