Sounds like "communication" issues got in your way . . .

Some observations for you to consider:
1. It is important on your part to follow your OB/GYN's recommendations regarding prenatal vitamins and iron (as needed) and an iron rich diet to insure that your hemoglobin and hematocrit are within normal range and that you aren't "anemic" as you go through this pregnancy. This may need to be regularly "monitored" by your OB/GYN as you get closer to delivery.
2. Speak with your OB/GYN physician about your views and discuss with him/her what they would do in an OB delivery emergency. The MD is ultimately responsible in an emergency situation for the team's response.
3. Make sure that the facility has a way to identify you as a "no blood" program participant upon your arrival and you need to provide your properly filled out "no blood advanced directive" to the facility. Make sure you have a clear understanding of options like the cell saver, erythropoietin, albumin, etc. and that your choices are clearly indicated on your paperwork. Have "the talk" with your relatives who do not share your point of view so that they are also clear about your wishes.
4. Be aware that in many facilities (even "no blood" ones!) there are no special activities planned for the JW "no blood" OB patient other than having emergency equipment (like the cell saver or volume expanders) available "just in case". This is not significantly different for the individual who won't accept blood than the one who will. Many facilities follow blood conservation techniques for all patients and most recognize that the OB patient can tolerate much lower hemoglobins after delivery than med surg patients due to their increased fluid volume, youth, and rapid recovery.
5. After doing the above, again approach your "consultant" to see if he/she has any further recommendations for you. Make sure you have given written "permission" for the facility to speak with your HLC member about your condition should the need arise. Because of current regulations, the staff may not feel that they can speak with your representative without this written confirmation that they are free to discuss your case with the representative.

Best Wishes for a successful delivery.

Caution should be used when considering the use of Cell Saver in OB/GYN. Amniotic Fluid Embolism remains a real threat to the life of the mother. Some facilities do not have a protocal for using cell saver with their OB cases. A special filter needs to be used and not all facilites are equipped to handle this type of request.

Richard Casas Could you just explain what you mean by cell saver and amniotic fluid embolism. Sorry I probably have heard of it but as another term maybe, there are so many names banded about for different procedures, I get so confused. Regards

Cell Saver is commonly known as (IBS) Intra-operative blood Salvage. Basically blood is collected from the operation site. Anticoagulant is added to prevent blood clotting in the equipment. The salvaged blood is collected in a reservoir and then sent to the cell salvage machine for washing. The automated cell salvage machine washes the blood and separates the waste products into the waste bag. Washed red blood cells are then pumped back to the reinfusion bag to be returned to the patient.

Amniotic Fluid (AF) is the liquid in which babies are suspended in the uterus. AF Embolism is a rare and incompletely understood obstetric emergency in which amniotic fluid, fetal cells, hair or other debris enters the mother's blood stream via the placental bed of the uterus and triggers an allergic reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and coagulopathy.

Visit: Amniotic fluid embolism - Wikipedia, the free encyclopedia for more information.

Hope this helps,

Take care
RC

I am concerned that RC does not adequately portray the current use of cell salvage in obstetrics. Amniotic fluid is removed/reduced using a leukocyte reduction filter. In the case of a patient refusing blood transfusions, it remains a viable option. This technique has been emerging for over ten years. In my experience the OB/GYN and Anesthesiologist is glad to have the leukocyte filter fitted cell saver standing by "just in case".


From 2000

CONCLUSIONS: Leukocyte depletion filtering of cell-salvaged blood obtained from cesarean section significantly reduces particulate contaminants to a concentration equivalent to maternal venous blood.

Amniotic fluid removal during cell salvage in the cesarean section patient.

Waters JH, Biscotti C, Potter PS, Phillipson E.


Departments of General Anesthesiology, Obstetrics and Gynecology, and Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.


BACKGROUND: Cell salvage has been used in obstetrics to a limited degree because of a fear of amniotic fluid embolism. In this study, cell salvage was combined with blood filtration using a leukocyte depletion filter. A comparison of this washed, filtered product was then made with maternal central venous blood. METHODS: The squamous cell concentration, lamellar body count, quantitative bacterial colonization, potassium level, and fetal hemoglobin concentration were measured in four sequential blood samples collected from 15 women undergoing elective cesarean section. The blood samples collected included (1) unwashed blood from the surgical field (prewash), (2) washed blood (postwash), (3) washed and filtered blood (postfiltration), and (4) maternal central venous blood drawn from a femoral catheter at the time of placental separation. RESULTS: Significant reductions in the following parameters were seen when the postfiltration samples were compared to the prewash samples (median [25th-75th percentile]): squamous cell concentration (0.0 [0.0-0.1 counts/high-powered field (HPF)] vs. 8.3 counts/HPF [4. 0-10.5 counts/HPF], P < 0.05); bacterial contamination (0.1 [0.0-0. 2] vs. 3.0 [0.6-7.7] colony-forming units (CFU)/ml, P < 0.01); and lamellar body concentration (0.0 [0.0-1.0] vs. 22.0 [18.5-29.5] thousands/microl, P < 0.01). No significant differences existed between the postfiltration and maternal samples for each of these parameters. Fetal hemoglobin was in higher concentrations in the postfiltration sample when compared with maternal blood (1.9 [1.1-2. 5] vs. 0.5% [0.3-0.7] ). Potassium levels were significantly less in the postfiltration sample when compared with maternal (1.4 [1.0-1.5] vs. 3.8 mEq/l [3.7-4.0]). CONCLUSIONS: Leukocyte depletion filtering of cell-salvaged blood obtained from cesarean section significantly reduces particulate contaminants to a concentration equivalent to maternal venous blood.


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From 2008

Existing cell salvage systems differ in their ability to clear contaminants and all require the addition of a leukocyte depletion filter.

Cell salvage in obstetrics.

Allam J, Cox M, Yentis SM.
Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, UK. docjoeya@yahoo.com
The safety of cell salvage in obstetrics has been questioned because of the presumed risk of precipitating amniotic fluid embolism and, to a lesser extent, maternal alloimmunisation. For these reasons, experience in this field is limited and has lagged far behind that in other surgical specialties. There has, however, been renewed interest in its use over recent years, mainly as a result of problems associated with allogeneic blood transfusion. Our aim was to review the medical literature to ascertain the principles of cell salvage, the ability of the process to remove contaminants, and its safety profile in the obstetric setting. The search engines PubMed and Google Scholar were used and relevant articles and websites hand searched for further references. Existing cell salvage systems differ in their ability to clear contaminants and all require the addition of a leukocyte depletion filter. Although large prospective trials of cell salvage with autotransfusion in obstetrics are lacking, to date, no single serious complication leading to poor maternal outcome has been directly attributed to its use. Cell salvage in obstetrics has been endorsed by several bodies based on current evidence. Current evidence supports the use of cell salvage in obstetrics, which is likely to become increasingly commonplace, but more data are required concerning its clinical use.

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

I apologize, I meant the explanation of Cell Salvage usage in general terms were it can be utilized with the exception of pregnant woman. Though the technology is available not all hospitals have protocols in place as of yet. My recommendation is for persons contemplating the use of cell saver in OB to inquire with the hospital. Hopefully discussions like these will promote it's acceptance.

Thanks
RC

hello my name is elizabeth i am a jehovahs witness from england and i had the same problem when i was pregnant with my first son with rhesus negative as i did not want anti-d as it has a blood fraction, i recently had a miscarriage and that brought up the issue again and i am having difficulty getting my views across, as the medical staff were not pleased i stated my stand on the issue, i am currently searching oput a synthetic version of anti-d.

my thoughts go out to you and others in the same predicament.

Hi everyone

I have just arrived home fromhospital after suffering a major blood loss - the worst this hospital has ever recorded. I lost a total of 4 Litres of Blood and ended up with a HB blood count of 33 (or 3.3) and was given hours to live. As one of JW's I refused a transfusion.

Lizzy and co - my only recommendation apart from all the other good suggestions is to ensure that the emergency, critical care and recovery sections of the hospital have the Hospital Liaison Committee protocols for acute anaemia available to them immediately. I was in the intensive critical care unit from 11am til 6pm that night before the hospital committee could talk to one of the head doctors and show them the protocol to follow. They had said that there was no other treatment apart from a blood transfusion that would help me... once the liaison brother showed them the protocol (they do have copies somewhere in the hospital - probably in the IN trays) it still took them til early hours of the next morning to give me EPO, Iron, folate and Vitamin B12 =- they had to order in teh iron transfusion. This is not a small community hospital either - a major hospital and is also used to teach our future doctors!

So my only suggestion is to ensure that they have the protocol in place and understand what fractions you will accept way before hand.

Take care.

thank you for that information, all the best with your recovery.