Worldwide Reports

Management of massive bleeding in a Jehovah’s Witness obstetric patient: the overwhelming importance of a pre-established multidisciplinary protocol

Belouchi, M | Blood Transfus. |
Manises General Hospital
Manises, Spain


Life-threatening massive bleeding is doubtlessly one of the biggest challenges in health care, especially in patients who reject allogeneic transfusion, such as Jehovah’s Witnesses. However, according to the principle of patients’ autonomy, our job is to accept their decision and provide them with the best possible assistance. We present a protocol for the management of massive post-operative bleeding successfully applied in a Jehovah’s Witness after a Caesarean section (CS).


The favourable outcome of this case demonstrates how a multidisciplinary patient blood management protocol allows treatment of massive bleeding without blood component transfusions (Figures 2 and ​and 3) thus observing the patient’s advance directives. As our hospital is a reference centre for treating patients who reject allogenic blood transfusion, from the very first contact and whenever feasible, the attending physician should refer such patients to the appropriate hospital team. Any professionals’ decision to refuse to be involved in the treatment of these patients should always be respected and accepted, provide assistance for the patient is guaranteed.


The therapeutic restriction imposed by a patient who rejects blood component transfusion may foster barriers to adequate treatment of episodes of massive bleeding. Thus, the availability of specific patient blood management protocols for these situations may facilitate physicians’ task and improve the patient’s safety and quality of assistance.

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