ArticleEuropean journal of case reports in internal medicine2025
Veno-Venous ECMO Support in the Management of a Jehovah's Witness with Severe COVID-19: A Case Report and Literature Review.
Article in European journal of case reports in internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Severe coronavirus disease 2019 (COVID-19) infection can lead to severe acute respiratory syndrome for which extracorporeal membrane oxygenation (ECMO) could be used in selected cases. Most Jehovah's witnesses (JWs) do not accept transfusion of blood and/or blood products. The use of ECMO for the management of JWs during the pandemic was challenging. Case report: We present a case of a JW with severe COVID-19 infection and multiple organ failure necessitating ECMO support for 20 days. We discuss the management challenges in patients who do not accept blood transfusions. A significant drop in the patient's haemoglobin and platelet count was observed throughout ECMO duration. An anti-coagulation-free ECMO circuit was maintained, and we did not observe any major circuit or patient complications. Conclusion: Management strategies to minimize blood loss, avoid bleeding, augment haemoglobin production, maintain ECMO circuit integrity without systemic anticoagulation, and reduce blood loss during ECMO decannulation are helpful in the management of JW followers on ECMO. We recommend treatment in such a situation at experienced centres with the involvement of a haematologist within an interprofessional team. LEARNING POINTS: Management of patients who are Jehovah's witnesses, who do not accept blood transfusion is challenging.Conservative transfusion strategies are feasible on selected patients supported by extracorporeal membrane oxygenation.Transfusion thresholds should be dynamic and reviewed daily.Mitigation of blood loss, rationalization of blood tests, and anticoagulation help reduce the need for transfusion.Transfusion targets and guidelines need revision, and it is best to adopt patient-specific targets tailored to each patient's needs.
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