Management of Jehovah's Witness patient in ICU Clarify which products may be used - Discuss early & document (e.g. some pts will accept PCC & Cryoprecipitate). - Consult ethics if unclear. Minimize blood loss pro-actively upon admission - All labs should be drawn in pediatric tubes. - Discontinue scheduled labs, limit to mission-critical tests spaced at wide intervals. Avoid coagulopathy - Avoid anticoagulants as a (including aspirin, NSAIDS). - When anticoagulation is essential, use lowest dose & most reversible agent. - Be aware of coagulation labs (periodically check platelets, INR, PTT). Consider stress ulcer prophylaxis if indicated Promote blood synthesis pro-actively if anemic - Erythropoietin 300 U /kg/day s.q. for two weeks - Empiric folate and B12 - iron sucrose to maintain ferritin > 100 & transferrin saturation > 20% Treat any bleeding aggressively - Early procedural control of bleeding to prevent ongoing blood loss. - Aggressive use of hemostatic agents (e.g. tranexamic acid, desmopressin). By Dr. Josh Farkas @ https://twitter.com/PulmCrit #Checklist #Jehovahs #Witnesses #patient #ICU #CriticalCare #Management
