The American Red Cross proudly proclaims “Give blood, save lives” Honorable, but is it true? Multiple studies on all-cause or total mortality have shown in fact the traditional practices of transfusing blood may actually worsen outcomes of not only cost, in-hospital stay, morbidity and time on a ventilator, but also both short-term and long-term mortality. Jehovah Witnesses, out of religious reasons, refuse blood products yet have the same rates of all-cause mortality as the general public. Recent guidelines are now recommending a more judicious use of blood transfusion to correct anemia. Do those receiving blood transfusions have worse outcomes than those with bloodless corrected anemia?

Despite their belief regarding transfusion, Jehovah's Witnesses do not have a higher mortality rate after traumatic injury or surgery. https://www.ncbi.nlm.nih.gov/pubmed/18580506

JWs and controls had similar early outcome. However, JWs had a nonsignificant trend toward decreased early mortality (2.6% vs. 3.6%; p = 0.318), reoperation for bleeding (3.2% vs. 4.7%; p = 0.070), atrial fibrillation (9.9% vs. 14.3%; p = 0.056), stroke (2.2% vs. 3.1%; p = 0.439), myocardial infarction (0.4% vs. 1.4%; p = 0.203), and length of stay in the intensive care unit (1.5 days vs. 2.0 days; p = 0.081). https://www.ncbi.nlm.nih.gov/pubmed/27197962

In patients with critical illness or bleed, restricting blood transfusions by using a hemoglobin trigger of <7 g/dL significantly reduces cardiac events, rebleeding, bacterial infections, and total mortality. https://www.ncbi.nlm.nih.gov/pubmed/24331453

Red blood cell transfusion in patients having cardiac surgery is strongly associated with both infection and ischemic postoperative morbidity, hospital stay, increased early and late mortality, and hospital costs http://circ.ahajournals.org/content/116/22/2544

In patients with critical illness or bleed, restricting blood transfusions by using a hemoglobin trigger of <7 g/dL significantly reduces cardiac events, rebleeding, bacterial infections, and total mortality. https://www.researchgate.net/publication/259316405_Impact_of_More_Restrictive_Blood_Transfusion_Strategies_on_Clinical_Outcomes_A_Meta-analysis_and_Systematic_Review

In more than 10,000 patients undergoing major surgery, intraoperative blood transfusion was associated with a higher risk of mortality and morbidity in surgical patients with severe anemia http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1933263

Three randomized trials involving a total of 2,364 patients found that essentially all outcomes were better with a restrictive vs. a liberal transfusion policy. http://epmonthly.com/article/transfusion-confusion-knowing-the-real-risks-of-blood-transfusion/

blood transfusion is associated with both short- and long-term mortality in the setting of ST-segment elevation MI. http://www.healio.com/cardiology/chd-prevention/news/print/cardiology-today/%7B3c0434c9-ead6-4801-8278-ab8c395b0dfb%7D/blood-transfusions-linked-with-mortality-in-patients-with-stemi

in patients undergoing cardiac surgery, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival. https://bmc2.org/system/files/private/whitepaper-on-transfusion-12-2-2013.pdf

Restrictive transfusion strategies are safe in most clinical settings. Liberal transfusion strategies have not been shown to convey any benefit to patients. http://www.bmj.com/content/350/bmj.h1354

Neurosurgical procedures in Jehovah's Witnesses are feasible, safe, and have similar outcomes to patients willing to accept transfusion when managed within a multidisciplinary blood management program. https://www.ncbi.nlm.nih.gov/pubmed/27641256

Outcomes after cardiac surgery are similar between Jehovah's Witnesses and general population, in centers applying rigorous blood patient management protocols. https://www.ncbi.nlm.nih.gov/pubmed/27079663

“Blood transfusion is far riskier than what people believe, and is responsible for billions in wasted healthcare dollars every year.” https://viewics.com/blog/the-united-states-risky-blood-transfusion-problem/

A restrictive blood transfusion strategy with hemoglobin trigger of <7 g/dL in patients with critical illness or bleeding significantly decreases rebleeding, cardiac events, and total mortality. http://www.the-hospitalist.org/article/restrictive-blood-transfusion-strategy-with-trigger-hemoglobin/

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