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Management of bleeding in a Jehovah's witness. Select the most appropriate action for each of the scenarios.

A 51 year old Jehovah's witness undergoing an elective AAA repair. He stated pre-operatively that he did not wish to undergo allogenic or autologous transfusion and this was appropriately documented during the consenting process. However, during the procedure there is significant back-bleeding from some large lumbar vessels and then is further massive bleeding from the top end anastomosis which necessitates re-clamping. The patient will not survive without a transfusion.

A 9 year old boy is brought in to A+E following an RTA. He is hypotensive and tachycardic. His Hb is 4.8. His father is a Jehovah's witness and states clearly that his son must not be given a blood transfusion in any circumstances. He states that this is what his son would want.

A patient has just been anaesthetised for an elective laparoscopic cholecystectomy. The theatre staff notify the surgeon that the patient is a Jehovah's witness. The surgeon was previously unaware and the issue of blood transfusion has not been discussed or documented.

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