No Health Risk When Jehovah's Witnesses Refuse Blood: Study

Heart-surgery survival similar between 'Witnesses' and transfused patients

No Health Risk When Jehovah's Witnesses Refuse Blood: Study

MONDAY, July 2, 2012 (HealthDay News) -- Jehovah's Witnesses routinely refuse blood transfusions, and new research suggests the religious custom has some benefits, at least when it comes to heart surgery.

The study of cardiac surgery patients found that the risk of dying was similar among 322 members of the Jehovah's Witness religion, who did not receive blood transfusions, and 322 patients who did get transfusions.

Moreover, the Jehovah's Witness patients had lower risks of additional surgeries, heart attack, kidney failure and blood infection than the others, according to the report published online July 2 in Archives of Internal Medicine.

"These practices that are done for Jehovah's Witnesses do not put them at risk for complications," said study author Dr. Colleen Koch, a cardiothoracic anesthesiologist at Cleveland Clinic in Ohio.

The Jehovah's Witness patients also spent less time in the intensive care unit and less time in the hospital overall than the transfused patients. However, 20-year survival was similar in both groups.

The findings may have implications outside of this specific population, which presented an opportunity for a "natural experiment," the authors said. "It behooves us to examine more closely some Jehovah Witness processes of care and implement them in our routine surgeries," Koch said.

The Jehovah's Witness practice of refusing blood transfusions stems from a belief that the Bible forbids ingesting blood.

Although screening techniques introduced in the 1990s ensure the blood supply is safer today than it used to be, blood transfusions still confer some risks. These must be balanced against the risks associated with anemia, a condition characterized by low levels of healthy red blood cells, which is the reason for transfusion. Anemia can cause severe fatigue and dizziness.

The standard on when to transfuse is based on expert opinion and varies by hospital and surgeon, Koch said. "There is no number for how low you can go in terms of anemia before ordering a blood transfusion," she said.

Concerns about U.S. blood-supply shortages has sired a movement to curb unnecessary transfusions. And, as more aging baby boomers undergo surgeries, they're likely to further strain the blood supply, Koch said. "We need to determine if there is anything we can do to decrease the need for blood without increased risk for complications," she said.

The authors noted that Jehovah's Witness patients follow blood conservation practices intended to avoid extreme anemia, including preoperative use of the hormone erythropoietin, iron and B complex vitamins.

Experts welcomed the report.

Dr. Gregory Fontana, chairman of cardiothoracic surgery at Lenox Hill Hospital in New York City, called the new study "a spectacular contribution."

But, "just because this paper is published, we cannot willy nilly start treating everyone like Jehovah's Witnesses," he said. "It does provide further evidence that transfusion with real indication carries a risk that heretofore has been underestimated."

Surgeons are taught to transfuse "reflexively" when anemia dips below a certain level, he explained. "This is too simplistic. We need to take a careful, careful look at a growing body of evidence that transfusion and use of blood-transfusion products should be taken very seriously and only occur with clear, clear indication."

Dr. Victor Ferraris, a professor of vascular surgery at the University of Kentucky Chandler Medical Center in Lexington, agreed in an accompanying journal editorial. "The findings of this analysis . . . add to the increasing data that suggest that more conservative use of blood transfusions would be in our patients' interest, in both Witnesses and non-Witnesses," Ferraris wrote.

More information

Learn about blood transfusions at the U.S. National Heart, Lung, and Blood Institute.

SOURCES: Gregory Fontana, M.D., chairman, cardiothoracic surgery, Lenox Hill Hospital, New York City; Colleen G. Koch, cardiothoracic anesthesiologist, Cleveland Clinic, Ohio; July 2, 2012, Archives of Internal Medicine, online
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