Management of acutely bleeding patients who refuse blood transfusion

Abstract

Patients who refuse blood transfusions yet require them for continued health present difficulties to physicians. In the elective setting, physicians and patients can calmly discuss benefits, risks, alternatives and referral to special centers that have a niche practice in bloodless medicine. Care of the acutely bleeding patient who objects to transfusion presents a uniquely challenging situation. Patients may refuse based upon general health considerations or deeply held religious beliefs. In the exsanguinating patient, lengthy conversations are not options nor are referrals to specialized centers. Management of the acutely bleeding transfusion objector is presented and highlights the medical, moral, ethical and legal issues physicians will find themselves confronted with. Surgical and pharmacological interventions that may be of benefit will also be discussed.