Surgical Indication and Blood Transfusion Policy for Patients Who Refuse Blood Transfusions for Religious Reasons during 3 Years in a Single Tertiary Center

Abstract

We performed a retrospective study of patients who refused blood transfusions for religious reasons during 3 years. Except for one emergency case, all eight patients who underwent planned surgery signed a transfusion refusal and exemption from responsibility certificate. Estimated blood loss ranged from a small amount to 500 mL. Patients accepted transfusion of derivatives of primary blood components, such as a plasma substitute（eight patients）, albumin solution（seven patients）, and intraoperative blood salvage（two patients）. Blood loss during surgery ranged from a small amount to 350 mL. No patients received blood products. Because of the small amount of estimated blood loss, we did not perform any specific perioperative strategies to avoid blood loss. Patients who completely refuse any blood transfusion in life-threatening situations might be transferred to another facility. In such situations, physicians follow the guidelines that medical providers should respect the patient’s autonomy for transfusion-free treatment. In case of rapid, massive blood loss, proper counseling and dialogue are required to convince patients to accept a blood transfusion.