FRCPath Haem Part 1 EMQs- Transfusion 94

Theme Jehovah's Witness

Option List

Choose the single best answer for each scenario.

A. Proceed with blood transfusion immediately

B. Respect the patient's refusal and continue bloodless management

C. Seek consent from relatives before transfusing

D. Refer to the High Court for a specific issue order

E. Review and follow the patient's Advance Decision document

F. Administer transfusion because refusal may result in death

G. Optimize haemoglobin with iron and/or erythropoietin before surgery

H. Transfer care to another willing clinician if unable to accept treatment limitations

Question 1

A 58-year-old Jehovah's Witness is scheduled for elective colorectal surgery in six weeks. His haemoglobin is 95 g/L due to iron deficiency anaemia. He refuses all major blood components but is willing to consider erythropoietin and intravenous iron. The surgeon believes the operation can safely be delayed.

What is the most appropriate next step?

Question 2

A 42-year-old Jehovah's Witness presents with severe gastrointestinal bleeding. She is conscious, competent, and produces a signed Advance Decision refusing red cells, platelets, plasma, and cryoprecipitate even if her life is at risk. Her haemoglobin is rapidly falling.

What is the most appropriate action?

Question 3

A 67-year-old unconscious man is brought to the emergency department following a road traffic collision. He is exsanguinating and requires immediate surgery. Family members state that he was a Jehovah's Witness, but no Advance Decision or refusal document can be located despite urgent efforts.

What is the most appropriate action?

Question 4

A 14-year-old Jehovah's Witness with acute leukaemia requires an urgent transfusion to prevent imminent death. Both parents refuse consent. The child also states that he does not want blood. There is sufficient time before deterioration to obtain legal advice.

What is the most appropriate next step?

Question 5

A consultant anaesthetist is asked to participate in a high-risk elective vascular procedure on a competent Jehovah's Witness patient. The patient refuses all blood products and the anaesthetist feels unable to provide care under those restrictions because of the anticipated bleeding risk.

What is the most appropriate action?