RHuEpo and granulocyte colony stimulating factors e. A copy of this should be placed in the patient record and the limitations on treatment made clear to all members of the clinical team. It is appropriate to have a frank, confidential discussion with the patient about the potential risks of their decision and the possible alternatives to transfusion, but the freely expressed wish of a competent adult must always be respected.
Useful resources to assist in the management of patients who refuse blood transfusions include:. Ortiz had never before been in an operating room.
Over the next few days, the pain intensified and she began to hobble. After consulting with doctors and receiving a CT scan, she was diagnosed with a spinal and retroperitoneal schwannoma, a tumor that arose from a nerve in the spine and ballooned outward into her abdomen. Biopsies showed that it was not malignant, but it had grown unchecked, probably for years, and wrapped itself around nervous tissue, blood vessels, and bone.
In hindsight, Ortiz said she thinks this type of tumor runs in her family. Decades earlier, her mother, who was living at her house, had felt dizzy and lightheaded and hurried to the bathroom. So she said a prayer and went to sleep. She signed herself in to a hospital in Florida that she believed would be sensitive to her beliefs. The doctors there, however, said that surgery would involve too much blood loss and could not be performed safely without transfusion. At a second hospital, also in Florida, Ortiz was once again turned away.
Abe Steinberger, a neurosurgeon who has been treating Witnesses for twenty years, agreed to work with Ortiz. Ortiz decided to travel north. Still, bloodless medicine requires more than surgical skill, as Steinberger himself also stressed. When Ortiz had pre-operative testing done in Florida, on the advice of a nurse who was familiar with Witnesses, she insisted that the phlebotomist use pediatric tubes and draw the minimum amount possible.
In the O. Kaufman first rotated through Englewood in , while completing a fellowship in critical-care medicine. In order to ensure that patients are not acting under duress, medical practitioners would be well advised to assure the patient that the nature of any treatment administered including blood transfusions is confidential and will not be disclosed by the practitioner to any third parties, and that third parties cannot gain access to hospital records without the consent of the patient.
It is furthermore advisable to have all discussions about possible blood transfusions with the patient privately, to ensure patient confidentiality and to allow them to disclose their wishes without pressure from family or the community. If this is suspected, it will facilitate decision-making on the part of the practitioner.
Skip navigation Search. Membership information Medicolegal advice A number of possible scenarios are discussed below:.
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