Management of Jehovah's Witness patient in ICU 



Clarify which products may be used 

 - Discuss early & document (e.g. some pts will accept PCC & Cryoprecipitate). 

 - Consult ethics if unclear. 

Minimize blood loss pro-actively upon admission 

 - All labs should be drawn in pediatric tubes. 

 - Discontinue scheduled labs, limit to mission-critical tests spaced at wide intervals. 

Avoid coagulopathy 

 - Avoid anticoagulants as a (including aspirin, NSAIDS). 

 - When anticoagulation is essential, use lowest dose & most reversible agent. 

 - Be aware of coagulation labs (periodically check platelets, INR, PTT). 

Consider stress ulcer prophylaxis if indicated 

Promote blood synthesis pro-actively if anemic 

 - Erythropoietin 300 U /kg/day s.q. for two weeks 

 - Empiric folate and B12 

 - iron sucrose to maintain ferritin > 100 & transferrin saturation > 20%

Treat any bleeding aggressively 

 - Early procedural control of bleeding to prevent ongoing blood loss. 

 - Aggressive use of hemostatic agents (e.g. tranexamic acid, desmopressin). 



By Dr. Josh Farkas @ https://twitter.com/PulmCrit



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