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Transfusion-Alternative Strategies in Neonatology

JEHOVAH’S WITNESSES. Transfusion-Alternative Strategies in Neonatology. Local Support and Beliefs. Back in 2000, Prof Jenkins, Wits University called for ”the education of health care professionals in blood-free management of countries with high HIV positive populations”.

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Transfusion-Alternative Strategies in Neonatology

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  1. JEHOVAH’S WITNESSES Transfusion-AlternativeStrategiesin Neonatology

  2. Local Support and Beliefs Back in 2000, Prof Jenkins, Wits University called for ”the education of health care professionals in blood-free management of countries with high HIV positive populations”

  3. Local Support and Beliefs In 2006 the University of Stellenbosch stated: “Blood products are not only expensive, but may be potentially dangerous . . . Therefore needs to be minimized by adherence to strict transfusion guidelines, limiting sample losses and by limiting infection and NEC as far as possible.”

  4. Local Support and Beliefs Your role in implementing Skin-to-Skin Kangaroo Mother Care, thereby reducing blood products and infections, is inspirational. A one-year study at Tygerberg Hospital KMC Neonatal Unit revealed:“The total cost of blood product transfusions decreased by 55% in total transfusion cost even though the number of patients increased by 19%.”

  5. Local Support and Beliefs To all mankind God said: “only, you shall not eat flesh with its life, that is, its blood.” Genesis 9:4 To the Jewish nation he repeatedly said,”for the life of every creature – its blood is its life; therefore I have said to the people of Israel: You shall not eat the blood of any creature, for the life of every creature is its blood.” Leviticus 17:11 To the Christians he stated three times to abstain from things polluted by idols and from fornication and from whatever has been strangled and from blood. Acts 15:20, 29; 21:25 NEW REVISED STANDARD BIBLE

  6. Local Support and Beliefs Our stand on blood The Watchtower, June 15, 2004, page 22.

  7. Local Support and Beliefs Natural Blood Fractions Why a Personal Decision? “ . . . Plasma, proteins (fractions) move from a pregnant woman’s blood to the separate blood system of her fetus. Thus a mother passes immunoglobulins (fractions) to her child, providing valuable immunity.” The Watchtower June 15, 2004

  8. PREOPERATIVE AUTOLOGOUS DONATION(PAD) Local Support and Beliefs Our View on Medical Procedures Using One’s Own Blood Donating own blood weeks before surgery.

  9. Local Support and Beliefs Regarding other procedures involving a patient’s own blood: “Each patient must decide how his own blood gets handled during the course of a surgical procedure, medical test or current therapy.” The Watchtower, October 15, 2000

  10. Local Support and Beliefs Cooley reported on cardiac surgery in 73 JW’s children less than 2 years of age. Operated for lesions of the heart and major vessels between 1963 to 1983. Eleven were less than 31 days old. “We have concluded that cardiac surgery can be performed on children of JW’s with acceptable mortality rates.” Texas Heart Institute Journal1985.

  11. Local Support and Beliefs German Heart Institute aim: Transfusion-free cardiac surgery even in neonates and small children. “Downsizing the cardiopulmonary bypass system, has now enabled a transfusion-free arterial switch operation in a 1700-gram prematurely born neonate.” Prof Roland Hetzer Journal Cardiac Surgery, July 2008

  12. Local Support and Beliefs Prof Robin Kinsley’s Team Cardiac Institute for Africa, Sunninghill Hospital, Johannesburg and Prof Susan Vosloo’s Team Chris Barnard Memorial Hospital, Cape Town  Have successfully operated on young JW children with Transfusion-alternative strategies.

  13. Local Support and Beliefs NETWORK EMERGENCY BELIEFS FAMILY ETHICS/LEGAL MEDICAL RESEARCH ALTERNATIVES ANEMIA BLOOD RISKS BURNS CANCER HEMOPHILIA NEWBORN SURGERY TRAUMA MEDICAL INDEX

  14. Ethical / Legal Jehovah’s Witnesses are not opposed to medical treatment, only blood. Has the local Hospital Liaison Committee for Jehovah’s Witnesses been contacted for assistance? Does a true emergency exist? Have the parents been heard from if at all possible?

  15. Ethical Legal 5. Has treatment with alternative nonblood management been fully explored? 6. Have the hazards of using blood been fully considered? 7. If a court order is issued, are limitations appropriate?

  16. TRANSFUSION-ALTERNATIVE STRATEGIES Anemia of prematurity • Stricter guidelines • Lowering transfusion trigger • How low? • Combining and reducing laboratory tests • Non-invasive tests • Combined therapy

  17. TRANSFUSION-ALTERNATIVE STRATEGIES Anemia of prematurity • Hymolytic disease of the newborn / hyperbilirubinemia • Antenatal Phenobarbital • Phototherapy • Intravenous Immunoglobulin • Respiratory distress • Delayed cord clamping • Resuscitation

  18. TRANSFUSION-ALTERNATIVE STRATEGIES Anemia of prematurity • Pulmonary morbidities reported to significantly decrease with: • Combined surfactant and nasal continuous positive airway pressure at delivery. • Lowered oxygen saturation goals. • Early amino acids administration reduced stress and improved early growth.

  19. TRANSFUSION-ALTERNATIVE STRATEGIES Anemia of prematurity Transfusion-alternative strategies in neonatology are being practiced at various institutions. Consultation before a crisis develops, is the preferred approach.

  20. Local Follow-up and Support Jehovah’s Witnesses maintain a network of Hospital Liaison Committees who are available at any time to assist with the management of individual Witness patients. HOSPITAL INFORMATION SERVICES 011 761 1000 Faculty of Law – Nelson Mandela Metropolitan University 2007.

  21. JEHOVAH’S WITNESSES Thank you!

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