[Home blood transfusion in France: Benefits and development terms]. / Transfusion à domicile : intérêt et conditions de développement dans le contexte français.

OBJECTIVES: Patients with cancers or malignant homeopathies can suffer from chronic anemia and be regularly transfused in hospitals. Most of the time, their performance status is low. Few local structures currently provide blood transfusion services and patients have to go under difficult and costing transportation to the hospital. The objective of this work is to evaluate benefits and development terms of home blood transfusion for patients with chronic anemia and having to get transfused regularly. METHODS: A field investigation-mixing observations and interviews and a literature review were conducted. RESULTS: Home blood transfusion represented a little part of home health care activity. When it was practiced, its organization was heterogeneous: it was sometimes performed by a doctor, sometimes by a nurse. Home blood transfusion was benefic for patients: it was more comfortable and it allowed them to avoid harmful transportation to the hospital. Few adverse events occurred during various experiments, all were mild. Before its revaluation in March 2018, home blood transfusion was not enough funded by National health insurance. Home blood transfusion also suffered from a lack of framework until the publication of recommendations in April 2018. CONCLUSIONS: Lack of a framework and sufficient funding prevented home blood transfusion development until changes that occurred in 2018. Therefore, this activity should develop in years to come. Allowing reducing unnecessary hospitalizations, home blood transfusion fit into French health national strategy.

Management of the Jehovah's Witness in Obstetrics and Gynecology: A Comprehensive Medical, Ethical, and Legal Approach.

IMPORTANCE: Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the literature about management of Jehovah's Witness patients in obstetrics and gynecology, most of them are case reports, and a comprehensive review about these patients including ethicolegal perspective is lacking. OBJECTIVE: This review outlines the medical, ethical, and legal implications of management of Jehovah's Witness patients in obstetrical and gynecological settings. EVIDENCE ACQUISITION: A search of published literature using PubMed, Ovid Medline, EMBASE, and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion, and ethical/legal considerations in Jehovah's Witness patients. RESULTS: Early diagnosis of anemia and immediate initiation of therapy are essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as antihepcidin antibodies and hemoglobin-based oxygen carriers. Options to decrease blood loss include antifibrinolytics, desmopressin, recombinant factor VII, and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches. CONCLUSION AND RELEVANCE: All obstetricians and gynecologists should be familiar with alternatives and "less invasive" options for patients who refuse blood transfusions.

[The legal status of blood's therapeutic products and consequences]. / Le statut juridique des produits thérapeutiques issus du sang et ses conséquences.

The first testimonies of humanity show a constant: blood was always surrounded with a sacred fascination. For years, it was not useful to define a legal status for blood, but healthy crisis, medical practices, had led to answer this question in a context of legal protection of human dignity and rights. Actually, the legal frame is moving and to know those statuses is helpful for a better understanding of the changes.

Transfusion-related acute lung injury (TRALI): A Canadian blood services research and development symposium.

Since the first description of transfusion-related acute lung injury (TRALI) more than 2 decades ago, we have only recently begun to learn how this disorder may occur and how to prevent it. Scientists from around the world have made great strides in identifying the possible causes of this condition. Blood banks and transfusion services have risen to the challenges of prevention. Recent introduction of restricting most plasma products to those obtained from male donors only has greatly reduced the incidence of TRALI worldwide. Scientists have recently identified the gene and protein for the human neutrophil antigen-3a associated with most mortality due to TRALI, and this presents an opportunity for a screening assay to prevent future TRALI-associated deaths. Finally, animal models of TRALI have provided insight into the possible mechanisms of this disorder and can be used to explore potential treatment modalities.

[Nurse/midwife responsibility]. / Responsabilité infirmier sage-femme.

Blood transfusion is a medical act which a nurse or midwife can do with a medical consent and only if a doctor can intercede when he is called. The following presentation reminds us of the nurse's and midwife's responsability when doing a blood transfusion. All the guidelines are laid down in the Public Health Code for nurses and midwifes as well as in the circular of the 15 December 2003. The nurse or midwife doing the transfusion must at all times respect the security guidelines, doing so along with close collaboration between nurse, midwife and doctor enables all transfusions to be conducted safely.

Marco legal del uso de sangre autóloga y otras alternativas a la transfusión alogénica / Legal framework for the use of autologous blood and other alternatives to allogenic transfusion

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[Jehovah's Witnesses refusal of blood: religious, legal and ethical aspects and considerations for anesthetic management]. / Fundamentos del rechazo a la transfusión sanguínea por los Testigos de Jehová. Aspectos etico-legales y consideraciones anestésicas en su tratamiento.

The refusal of Jehovah's Witnesses to agree to blood or blood product transfusion based on religious beliefs is one of the most challenging conflictive issues health care givers have to face today. Such conflict is a by product of the ideological and religious diversity in society today. The perioperative care of such patients constitutes a genuine challenge for anesthesiologists and surgeons from technical, scientific, ethical, and legal perspectives. We review the reasons why Jehovah's Witnesses refuse transfusion and discuss the ethical, legal, and anesthetic aspects of their care. The literature up to August 2005 was reviewed by MEDLINE search. The following search terms were used: Jehovah's Witnesses, anesthesia (and anaesthesia), legislation and jurisprudence, ethics, blood transfusion, alternatives, anemia (and anaemia), erythropoietin, trigger, and critical care. To further cover ethical and legal aspects, we reviewed current laws in Spain and similar practice settings.

Fundamentos del rechazo a la transfusión sanguínea por los Testigos de Jehová. Aspectos ético-legales y consideraciones anestésicas en su tratamiento / Jehovah's Witnesses refusal of blood: religious, legal and ethical aspects and considerations for anesthetic management

Uno de los conflictos asistenciales que la medicinaactual afronta, consecuencia de la pluralidad ideológicay religiosa de nuestra sociedad, es el rechazo a la transfusiónde sangre y derivados sanguíneos por los Testigosde Jehová a causa de sus creencias religiosas. El tratamientoperioperatorio de estos pacientes supone un retopara anestesiólogos y cirujanos, tanto desde el punto devista técnico y científico, como ético y legal. Revisamoslos fundamentos del rechazo a la transfusión sanguíneapor los Testigos de Jehová, así como los aspectos éticos,legales y consideraciones anestésicas en su tratamientoPara ello hemos revisado la literatura médica existentehasta agosto de 2005 mediante búsqueda en MEDLINE,utilizando los términos de búsqueda "Jehovah’s Witnesses,anaesthesia, legislation and jurisprudence, ethics,blood transfusion, alternatives, anaemia, erythropoietin,trigger, critical care". Para cubrir los aspectos éticos ylegales se ha revisado la legislación vigente en España yen otros países de nuestro entorno

The refusal of Jehovah's Witnesses to agree to bloodor blood product transfusion based on religious beliefs isone of the most challenging conflictive issues health caregivers have to face today. Such conflict is a by product ofthe ideological and religious diversity in society today.The perioperative care of such patients constitutes agenuine challenge for anesthesiologists and surgeonsfrom technical, scientific, ethical, and legal perspectives.We review the reasons why Jehovah's Witnesses refusetransfusion and discuss the ethical, legal, and anestheticaspects of their care. The literature up to August 2005was reviewed by MEDLINE search. The followingsearch terms were used: Jehovah's Witnesses, anesthesia(and anaesthesia), legislation and jurisprudence, ethics,blood transfusion, alternatives, anemia (and anaemia),erythropoietin, trigger, and critical care. To furthercover ethical and legal aspects, we reviewed current lawsin Spain and similar practice settings

[Blood transfusion: history ethic and law]. / La trasfusione di sangue: storia, etica e diritto.

The paper outlines the stages of the history of blood transfusion from the earlier attempts and difficulties to the important discoveries of the early XX century and to recent developments, that have made blood transfusion an easy life-saving method. The authors also examine the ethical motivations underlying transfusion refusal as well as the economical measures of solidarity contained in the Italian law n. 210/1992 to protect HIV HCV or HBV patients, especially those having contracted infection because of mandatory vaccinations or infected blood transfusions.

Oncological management of pediatric cancer patients belonging to Jehovah's Witnesses: a two-institutional experience report.

OBJECTIVES: Aim of this study was to analyze the feasibility of oncological treatment in pediatric patients belonging to Jehovah's Witnesses and to describe the changing policy in performing transfusions and supportive care measures at two German pediatric cancer institutions. PATIENTS AND METHODS: Over a period of 16 years 21 treatments according to the current cooperative protocols were performed in 14 children of Jehovah's Witnesses. Various hematological supportive care measures such as supplementation with iron, human erythropoietin, interleukin 11, granulocyte colony-stimulating factor and autologous or allogeneic stem cell rescue had been applied. For comparison matched pairs treated in our hospitals not belonging to Jehovah's Witnesses and 50 pediatric and adult oncological patients belonging to Jehovah's Witnesses reviewed from the international literature were analyzed with respect to transfusions and outcome. RESULTS: So far, 9 of 14 children are surviving 16-195 months (median 26 months). During the primary therapy they received markedly less transfusions than the control cohort (-39,1% red blood cell transfusions and -37,5% platelet transfusions). The review of 50 reported cases showed that oncological therapy can also be successfully performed with a restricted transfusion regimen in children and particularly in adults. CONCLUSION: Pediatric cancer patients belonging to Jehovah's Witnesses can be treated similarly to other patients. A restrictive transfusion policy and the broad application of hematopoietic supportive care measures may reduce transfusions. This treatment policy and a continuous collaboration with the Hospital Liaison Committee for Jehovah's Witnesses appears to create an oncological treatment situation with a high compliance of patients and parents where court orders may not be necessary.

Transfusion-free treatment of Jehovah's Witnesses: respecting the autonomous patient's rights.

Do six million Jehovah's Witnesses mean what they say? Muramoto's not-so-subtle proposition is that they don't, because of a system of control akin to the Orwellian "thought police". My response is that the fast developing cooperative relationship between our worldwide community and the medical profession as a whole, and the proven record of that community's steadfast integrity in relation to their Christian principles is the evidence that we do! I seek to highlight the inaccuracy of information, which Muramoto admits came largely from dis-enchanted ex-members, by quoting "established" medical ethical opinion that refusal of blood transfusions must be respected as evidence of patient autonomy. Personal experience of my work on hospital liaison committees for Jehovah's Witnesses is reviewed and I endeavour to prove that our view of blood, and its association with life, goes to the very core of the human psyche. Lastly I suggest that faith transcends rationality. Human beings are more than just minds! Our deep moral sense and consciousness that our dignity is diminished by living our lives solely on the "self interest" principle, lies at the heart of true personal autonomy. Maybe it's a case of "two men looking through the same bars: one seeing mud, the other stars".