JAMA Perspectives Article Highlights Safe and Effective Treatment of Severe Anemia Without Blood Transfusion for Patients at Risk of Marginalization

Columbia, MD – Much of the medical literature regarding the care of Jehovah’s Witnesses is written from the perspective of the clinical care team. In a new perspectives article published in the November 23 issue of the Journal of the American Medical Association (JAMA) Internal Medicine, a case is presented from the perspective of a patient. The article, “No Bad Blood – Surviving Severe Anemia Without Blood Transfusion,” describes the care experience of a patient who was safely and effectively treated for severe anemia without blood transfusion.

The opinion piece is presented from the viewpoint of a non-English speaking patient visiting from another country who had been denied treatment in the past due to her refusal of blood transfusion. Severe anemia is traditionally treated with blood transfusion, sometimes with no diagnosis of the underlying cause of the anemia, exposing patients to potential risks. This article demonstrates that if meticulous evaluation is made to determine the etiology of the anemia, the patient’s wishes can be respected and appropriate, effective treatment can be provided without blood transfusion.

The article states that sometimes treating a patient without blood transfusion can be viewed as “troublesome” or cause an ethical dilemma, as the physician may feel that by complying with the patient’s wishes they are providing suboptimal care. If the physician or care team begins to feel that the patient is troublesome it could lead to an increased risk of marginalization of the patient or poor clinical outcomes. In the past, this has often been the experience of Jehovah’s Witness patients who present to hospitals with severe anemia.

 “When treating a patient who is un-able to receive blood transfusion, we must carefully manage the patient’s needs while balancing our internal and implicit biases regarding blood product administration,” said Kelly Johnson-Arbor, MD, medical director of Hyperbaric Medicine in the MedStar Health Center for Wound Healing and Hyperbaric Medicine. “In an effort to provide optimal care for Witness patients, many hospitals have recently established multidisciplinary ‘bloodless medicine and surgery programs.’ What we are finding is that many medical professionals involved with these programs are applying lessons learned from treating this patient population to enhance the care of all patients.”

Dr. Johnson-Arbor is an expert in the fields of Emergency Medicine, Medical Toxicology and Hyperbaric Medicine, she is an Associate Faculty member at the MedStar Health Institute of Quality and Safety and contributing author to the website of the MedStar Health International Training Center for Bloodless Medicine, medstarbloodless.org. Co-author Richard Verstraete, RN is coordinator of the MedStar Georgetown University Hospital Bloodless Medicine and Surgery Program and also contributes to articles featured on medstarbloodless.org website.

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About the MedStar Health Institute for Quality and Safety
The mission of the Medstar Health Institute for Quality and Safety is to partner with patients, their families, and those that take care of them to improve patient care outcomes and reduce the global burden of preventable harm. Established by Medstar Health, the largest healthcare provider in Maryland and the Washington, D.C., region, the Institute provides a global infrastructure in which leaders, front-line care givers, patients and family members jointly develop, educate, assess, and advocate for patient safety and clinical quality initiatives. For more information, visit medstariqs.org.  

About the MedStar International Training Center for Bloodless Medicine
The mission of the MedStar International Training Center for Bloodless Medicine (MedStar Bloodless) is to improve quality of care and patient safety for Jehovah’s Witnesses worldwide by providing free training in the tools and techniques of bloodless medicine and surgery. For more information, visit medstarbloodless.org.