Evaluate for other treatable anemic conditions
Minimize Blood Loss
pediatric tubes or 1 cc testers
Maximize blood production
erythropoeitin contains albumin treat for several days and then switch to TIW Total iron needed Fe (mg)=0.3 x body weight (lbs) x (100-((Hb x 100)/14.8)) Iron dextran can be given IV
Maximize Cardiac Output
Maximize Preload while avoiding dilution Dobutamine to bolster output Increase O2 Conten-drive PaO2 to supranormal levels 100-300 units/kg Increase Offloading of HB-make patients hypercarbic to increase curve shift to right Decrease Metabolic Rate-hypothermia paralytics
Legalities
The idea that a parent can be compelled to have a transfusion against his/her wishes in the interests of his/her children arises from a single case, which is known as “Application of the President and Directors of Georgetown College” (331 F.2d 1000 (D.C.Cir.)), and which was decided by a single U.S. Appeals Court judge, the eminent jurist J. Skelly Wright, after a brief hearing, essentially at the patient’s bedside. Judge Wright ordered the transfusion, citing a number of reasons, one of which was the government’s perogative as parens patriae to prevent this “most ultimate abandoment.” In the end, in a written decision, he admitted that he was simply faced, in the middle of the night, with the choice of life or death and that he looked hard for a reason to choose life. There was some evidence that the patient, Mrs. Jones, a Jehovah’s Witness who was in extremis, was willing to have the transfusion if that did not require her to consent to it, since she felt that the prohibited action was consenting rather than being transfused. The case went no further. The D.C. Circuit Court of Appeals, on which Judge Wright sat, refused an en banc re-hearing and the Supreme court refused a certeriori petition. Most commentators think that the singular nature of this decision deprives it of any precedential importance, and it has not subsequently been followed (although frequently referenced) by other courts. In summary, it is most unlikely that a court would rule in favor of an unwanted transfusion
because the lack of it might deprive a child of his parent, whether in the context of an action to force the transfusion or a later lawsuit based on the honoring of that refusal. Tom Stinson, M.D.