The jehovah’s witness patient

What is scoliosis?

Scoliosis is characterized by one or more lateral curvatures of the spine. The lateral curvatures are associated with rotation of vertebrae and can result in deformity of the rib cage. Curves are classified as structural or nonstructural. Structural scoliosis fails to correct (improve) with side bending toward the convex side. Nonstructural scoliosis corrects with side bending toward the convex portion. The curve associated with nonstructural scoliosis is flexible.

How is scoliosis classified?

Idiopathic scoliosis is the most common form of scoliosis. There may be a genetic component, but, as the name implies, its cause is unknown. Idiopathic scoliosis can be divided into three different types: infantile, juvenile, and adolescent.

  • Infantile idiopathic scoliosis is diagnosed between birth and up to 3 years of age and has a higher incidence among boys. Most of these curves resolve spontaneously without treatment. The curves of infantile idiopathic scoliosis are thought to be secondary to molding in utero.

  • Juvenile idiopathic scoliosis is diagnosed between the ages of 3 and 10 years and is more evenly distributed between boys and girls.

  • Adolescent idiopathic scoliosis occurs between age 10 years and skeletal maturity and is more commonly seen in girls.

There are many causes and associated conditions in which scoliosis may occur ( Box 49-1 ).

BOX 49-1

Classification of Scoliosis

  • Congenital

    • Myelomeningocele

    • Hemivertebrae

  • Connective tissue disorders

    • Ehlers-Danlos syndrome

    • Marfan syndrome

    • Osteogenesis imperfecta

    • Rheumatoid arthritis

  • Idiopathic

    • Infantile (<3 years)

    • Juvenile (3–10 years)

    • Adolescent (>10 years)

  • Neuromuscular diseases

    • Myopathic

      • Arthrogryposis

      • Muscular dystrophy

    • Neuropathic

      • Cerebral palsy

      • Riley-Day syndrome (dysautonomia)

      • Poliomyelitis

      • Spinal cord tumors

  • Neurofibromatosis

  • Trauma

    • Fracture

    • Post–rib resection

How is the curvature assessed in patients with scoliosis?

The Cobb method ( Figure 49-1 ) is a commonly used technique for measuring the scoliosis curvature. In the Cobb method, lines are drawn at the uppermost border of the curvature and at the lowermost border of the curvature. Perpendicular lines are drawn from the two original lines, and the angle made by the intersecting perpendicular lines is the degree of curvature.

FIGURE 49-1 ■

Cobb method.

(From the Scoliosis Research Society, 2003; with permission.)

What will a jehovah’s witness refuse and accept in terms of blood transfusions?

The policy of the Watchtower Bible and Tract Society (WTS) with regard to blood is based on Jehovah’s Witnesses (JW) elders’ interpretation of biblical passages. The JW elders determined that blood transfusions violate God’s law. JWs believe that blood removed from the body must be discarded. Many JWs refuse blood transfusions of whole blood and its primary components including red blood cells, white blood cells, platelets, and plasma. Fractions obtained from primary blood components are potentially acceptable to JWs ( Figure 49-2 ).

FIGURE 49-2 ■

Blood components acceptable to Jehovah’s Witnesses.

(Reprinted with permission from Wong CH, Thomas MJ. Meeting the clinical challenge of care for Jehovah’s Witnesses. Transfus Med Rev 2004;18:105–16.)

JWs do not participate in preoperative autologous blood donation. JWs embrace the use of nonblood alternatives. Intraoperative acute normovolemic hemodilution or cell salvage may be acceptable to some JWs. In such cases, many JW patients require maintenance of a continuous circuit at all times.

It is prudent to establish an unambiguous list of components and techniques that are acceptable and unacceptable to each patient before anesthesia. What is acceptable to one person may be unacceptable to another. Each JW patient must decide individually whether to accept or decline various blood fractions and procedures.

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Jul 14, 2019 | Posted by in ANESTHESIA | Comments Off on The jehovah’s witness patient
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