An adult Jehovah's witness requires surgery during which significant blood loss is probable. Describe your management.

This is a not uncommon problem which influences preoperative preparation, requires some modification of anaesthetic management and includes an ethical dimension. This situation can be far from easy and the question seeks both a mature overview and a rational anaesthetic plan.

Introduction

Jehovah's Witnesses, of whom there are an estimated 150 000 in the UK, interpret the scriptures in a literal way, which means that they extrapolate to blood transfusion the biblical prohibition about eating blood. Perioperative management requires elucidation of their precise beliefs before introduction of the various options for optimising their surgical outcome.

Religious beliefs

• Witnesses have a range of attitudes. The strictest individuals will accept neither blood, blood products, platelets, albumin, immunoglobulins nor clotting factors. They will not accept autologous transfusion (because the blood has lost contact with the body), nor cell savers, but may accept cardiopulmonary bypass.

• The anaesthetist must establish precisely what is acceptable to the patient and must treat accordingly. The patient has the absolute right as an adult to refuse treatment. If the anaesthetist finds the demands difficult then the patient should be referred on to other colleagues as appropriate.