NoBlood

Mark Jacobson · #1 (**permalink**) 02-28-2005, 05:25 PM

I am a member of the Hospital Liaison Committee for Jehovah's Witnesses for Brisbane, Australia. On Friday I and a fellow HLC member gave a presentation to about 25 doctors at a small(ish) regional public hospital just outside of Brisbane. Afterward I was approached by a obstetrician who asked for our help in setting up a protocol for postpartum Witness mothers experiencing blood loss. I would be grateful for any information or articles that would be appropriate her needs.

jgraziani · #2 (**permalink**) 03-04-2005, 06:49 AM

Have you seen the document distributed by HIS entitled
Clinical Strategies for Avoiding and Controlling Hemorrhage and Anemia Without Blood Transfusion in Obstetrics and Gynecology. It is dated 12/02. Excellent. If you don't have one or can't get one from HIS let me know and I will mail it to you asap.
Jan

Jan B. Wade · #3 (**permalink**) 03-04-2005, 04:55 PM

Hello Mark. I have an anemial protocol to share. Email me. We can also discuss building a treatment protocol.

Janbwade@optonline.net

Mark Jacobson · #4 (**permalink**) 03-06-2005, 12:34 PM

Thanks Jan. Yes I have forwarded the document you mentioned which, as you said is excellent, also "The Worldwide Need for Education in Nonblood Management in Obstetrics Obstetrics and Gynaecology" by J Mervyn Thomas, 1994. I don't know what else the doctor needs but, owing to different attitudes here, I'd rather give her more than she needs than to not live up to her expectations. Jan Wade from NJ has offered assistance, so I'm taking her up on her offer. Thank you again. Mark.

Jan B. Wade · #5 (**permalink**) 03-07-2005, 04:51 AM

When asking for a protocol the doctor probably wants a series of 'what to do next' steps. These will need to go through committee and then adopted by the medical staff.

Also - The protocol should include pre-delivery patients with "low" hgb levels.

When opening this issue the hospital will need to examine current post partum protocols. In other words, your MD's or mid-wives are already treating anemia orally. They are also using RBC's. The oral treatment may fit in some cases. You are replacing the use of RBC's so - what is the current trigger for using those? etc.

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The protocol should spring from a policy stating the hospitals intent to treat anemic pre-delivery and post partum patients.

ie - XYZ medical center recognizes the benefits of treating anemia in pre-delivery and post partum patients. XYZ recognizes the benefits of avoiding banked blood whenever possible. (If your hospital is in the mood to mention JW patients this is a good place to insert appropriate language - Realizing JW patients refuse blood a protocol is needed to use appropriate non-blood management etc)

(next identify the condition or hgb level that will trigger the protocol)

Any patient with a pre-delivery hgb of X (10?) will be treated pre-delivery using the protocol

Any patient with a post-delivery hgb of X (9? 8?) will be treated using the protocol

(then outline the protocol)

For cases of "moderate" anemia (X hgb)

-xxx mg of po iron daily
- x mg of folic acid po daily
- xxx mg vit C deep Sub Q daily
- xxxx micrograms Vit B12 deep sub Q 1 time

For severe (hgb of x or below)

- xxx ferros gluconate IV
- xxxxx units of EPO
- x mg of folic acid po daily
- xxx mg vit C deep Sub Q daily
- xxxx micrograms Vit B12 deep sub Q 1 time

Until target hgb acheived

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The discovery process of your anemia protocol committee is vital. It will raise the bar in the hospital. The process creates advocates for alternatives to blood.

Hope this helps you.

permalink · #6 (**permalink**) 05-10-2005, 04:43 PM

I am a Jehovah's Witness mother who has experienced severe blood loss due to an ectopic pregnancy that ruptured. I was taken from Charleville to Royal Brisbane and went from ?12d/l to 1.7d/l surviving my ordeal!

I have allowed my files from Royal Brisbane to be viewed by the doctors if ever they come across this scenario again, if that helps. I was put on life support to help the load on my heart which I feel helped me live. I have no after effects from the blood loss like they all thought especially since I had to go up in a plane to altitudes that deemed dangerous.!

Hoping this may help & I'm also interested in this area myself as planning on another child in the near future!

Jan Wade's protocol for severe anemia sounds like the protocol I was on with myself taking Iron and folic acid on top in the form of tablets and food sources every day. I left hospital 2 weeks after my ordeal.

Paula Hallinan

NoBlood

Postpartum Protocol