# Jehovah's Witness Needing Critical Care: A Narrative Review on the Expanding Arsenal

## TL;DR

This paper reviews medical strategies for treating Jehovah's Witnesses who refuse blood transfusions, focusing on non-blood alternatives and new oxygen carriers.

## Contribution

The paper highlights the expanding use of artificial oxygen carriers and intravenous iron supplementation for patients with religious objections to blood transfusions.

## Key findings

- Artificial oxygen carriers show promise in emergency treatment for patients refusing blood transfusions.
- Intravenous iron supplementation is increasingly supported in ICU settings for managing severe anemia.
- Further research is needed on the role of hepcidin in complementing non-blood transfusion therapies.

## Abstract

Present day Jehovah's Witness (JW) religion accounts for 8.5 million followers. A tenant feature of the JW faith is religious objection to transfusions of blood and blood products. Interpatient variability, as it pertains to blood and blood products may occur; hence, a confidential interview will determine which products individual may consent to (Marsh and Bevan, 2002). This belief and practice place great restrictions on treating medical professionals in scenarios of life-threatening anaemia and active haemorrhage. The review to follow explores the physiological and pathophysiological consequences of severe anaemia. Non-blood transfusion practices are explored, many of which are potentially lifesaving. Particular attention is drawn to the evolving science involving artificial oxygen carriers and their use in emergency situations. A greater safety profile ensures its future use amongst religious objectors to be greatly beneficial. Intravenous iron supplementation has enjoyed a lively debate within the critical care community. A review of recent systematic and meta-analysis supports its use in the ICU; however, more investigation is needed into the complementary use of hepcidin.