Jehovah’s Witness

Jehovah’s Witness patients often refuse blood products due to religious beliefs, but their acceptance of specific treatments varies based on individual interpretation and discussion with their religious advisors. Here’s how different clotting products are categorized:

Principles

•Ascertaining their wishes ahead of time in detail as to what whole or part blood products they may or may not accept. Don’t assume one way or another •Being cognisant of things that may not immediately be obvious that include human blood products e.g. T99m tracer for sentinel node biopsy is attached to a human colloid •Be aware which haemostatic agents are based on human blood products. •If unable to ascertain their wishes or an advanced directive would need to proceed with duty of care

Generally Refused (Considered Blood Products)

These are derived from whole blood and typically not accepted:

1. Fresh Frozen Plasma (FFP) – Contains all clotting factors.
2. Cryoprecipitate – Rich in fibrinogen, Factor VIII, vWF, and Factor XIII.
3. Platelets – Direct blood product.
4. Whole Blood, Packed RBCs, or White Cells – Strictly prohibited.

Potentially Acceptable (Fractionated Products – Case-by-Case Basis)

Some Jehovah’s Witness patients may accept small-volume, fractionated plasma derivatives, such as:

1. Prothrombin Complex Concentrate (PCC) – Contains Factors II, VII, IX, X (e.g., Beriplex, Octaplex).
2. Fibrinogen Concentrate (e.g., RiaSTAP) – Alternative to cryoprecipitate.
3. Recombinant Factor Products (synthetic, not blood-derived):
   • Recombinant Factor VIIa (e.g., NovoSeven).
   • Recombinant Factor VIII / IX (for hemophilia).
4. Albumin-Based Solutions – Some may accept if highly purified.
5. Antithrombin III, Protein C & S Concentrates – If derived from plasma, acceptance varies.
6. Prothrombinx

Fully Acceptable (Non-Blood Alternatives)

1. Tranexamic Acid (TXA) – Antifibrinolytic agent.
2. Desmopressin (DDAVP) – Increases Factor VIII and vWF release.
3. Vitamin K – Helps in clotting factor synthesis but does not replace factors.
4. Erythropoietin (EPO) – Stimulates RBC production, reducing transfusion need.
5. Iron Therapy – IV or oral for anemia management.