LETTERS TO THE EDITOR
There is no doubt that most Jehovah’s Witnesses feel that the external tubing of a heart-lung bypass circuit is an extension of their own circulation; otherwise, they would not agree to undergo cardiopulmonary bypass using an extracorporeal circuit. Further, movement—or better, stasis—of blood during cardiopulmonary bypass is not an issue, as has been correctly pointed out by Sharon Vernon, the Director of the Bloodless Medicine Institute in Cleveland, OH. At no point, have we questioned or even mentioned this topic in our publication (1). If stasis of blood really were an issue for Jehovah’s Witnesses, successful cardiopulmonary resuscitation after cardiac arrest would be an issue as well. Fortunately, this is not the case.
We agree with Drs. Waters and Potter that the key in treating Jehovah’s Witnesses is to maintain the continuity of blood with the patient. This, however, is not provided when a Haemonetics Cell Saver (Munich, Germany) is used, because blood is processed in batches. While being washed in the Latham bowl, a clamp interrupts the continuity of blood between the bowl and the patient. This was the argument against cell salvage of the specific patient described in our case report. To our knowledge, the CATS (Fresenius, AG, Bad Hamburg, Germany) is the only available autotransfusion device allowing the anesthesiologist to overcome this problem. We explained this system to our patient, and she finally gave her permission to use the CATS.
As outlined in our previous publication and in the corresponding letter to the editor by Drs. Waters and Potter, the acceptance of autotransfusion devices is up to each individual patient. If, as in our case, a patient does not accept such discontinuous blood processing because of the lost continuity of blood between the Latham bowl and the patient’s own circulation, then the anesthesiologist has to accept this decision. However, the CATS allows continuous blood processing, maintaining the continuity of processed blood with the patients circulation at any time. Therefore, the anesthesiologist should emphasize that any patient who refuses this continuous system should also refuse the heart-lung machine.
Finally, we want to point out, that of course Jehovah’s Witnesses can be managed by using any other autotransfusion system, provided the patient agrees to its specific technique.
Michael Booke MD, PhD
1. Booke M, Schmidt C, Van Aken H, et al. Continuous autotransfusion in a Jehovah’s Witness undergoing cardiopulmonary bypass grafting. Anesth Analg 1999; 89:262–3.