10/30 rule: A guideline or "rule" that developed among clinicians that stated a patient likely should be transfused if hemoglobin level fell below 10 or the hematocrit below 30. It was a crude estimation of oxygen needs of the body based on speculations from studies done on animals from the 1930's to the 1950's. While it is no longer accepted as standard particularly since the 1980's, some doctors are still influenced by it.

Advanced Medical Directive: A legal document filled out and signed by a competent adult in advance of any medical/surgical treatment. This document states the medical preferences of the patient. It is empowered and legally binding in the event of an adult patient's inability to make future conscience or competent decision.

Aggregation: The act of gathering or amassing, as into a heap or pile.

Albumin (serum albumin): A crystallizable albumin or mixture of albumins that normally constitutes more than half of the protein in blood serum, that serves to maintain the osmotic pressure of the blood, and that is used in transfusions especially for the treatment of shock.

Aminocaproic acid (Amicar): A medication that slows or stops the breakdown of blood clots. During clot formation, while clotting factors are at work, chemicals are released simultaneously that serve in a counterbalancing way to break down the clot, ensuring that does not grow too large. However, if the clotting mechanism is impaired, as in hemophilia or low platelet levels, this breakdown activity may need to be slowed or stopped so that there is sufficient clot formation to prevent bleeding.

Anemia: The name for a group of blood diseases caused by problems with red blood cells.

Aparoscope: A device similar to an Endoscope that is used to view internal structures of the abdominal cavity. A small incision through the abdominal wall is made and the laparoscope is normally inserted while the patient is under a mild anesthesia. This device permits the viewing of internal organs of the abdominal cavity such as liver, spleen and pancreas. Some minor surgical procedures, such as removal of gall bladder, can be performed with this device.

Aprotinin: A medication derived from bovine lung tissue used during cardiac surgery to lessen blood losses. It is presently available in the United States and is used extensively in Europe.

Argon beam coagulator: A device that employs a beam of ionized argon gas to coagulate vessels and is capable of cauterizing larger vessels. This device is becoming more widely available and is most often used in surgeries involving organs that bleed easily, such as liver and spleen.

Arterial embolization: A procedure that employs either a mechanical or chemical agent to close off arteries that are actively bleeding. A special catheter is placed into the lacerated artery ahead of the bleeding and then a substance is injected that closes off the artery. This procedure is quite helpful when there is heavy bleeding in the pelvic, gynecological, and abdominal areas. This technique is used frequently, but not all facilities may be thoroughly familiar with its use.

Cancer: This is now a general term for more than 100 diseases that are characterized by uncontrolled, abnormal growth of cells. Cancer cells can spread locally or through the bloodstream and lymphatic system to other parts of the body.

CBC: Complete Blood Count

Colloids: A family of intravenous fluids which are composed of water mixed with very small particles of proteins or other materials. These small particles do not dissolve in water. Colloids are similar to the makeup of milk and are used to maintain blood protein levels that stabilize fluid balances and circulating volume in the body. Members of the colloid family of fluids include dextran, gelatin and hetastarch.

Crystalloids: A family of intravenous fluids which is made up of water mixed with various dissolved salts and sugars. These fluids are used to help maintain circulating blood volume in the body. Members of crystalloid family include Ringer's lactate, normal saline and hypertonic saline.

Desmopressin (DDAVP): A medication that greatly improves clotting capacity in almost all patients. Desmopressin works in two ways. First, it causes blood clotting factors that are stored in the cells to be released into the blood stream, causing high levels for short periods of time. Second, it has the ability to constrict arteries and thus decrease blood flow. Desmopressin is a valuable aid in stopping bleeding quickly and, since its effect is short in duration (30-60 minutes), it can be given without fear of excessive clotting.

Dextran: An intravenous fluid of the colloid family. It is made primarily of distilled water and a high molecular weight sugar molecule and is used as a plasma volume expander.

Direct pressure: A technique of applying pressure to a laceration or abrasion usually with some form of bandage material. This direct pressure can close off small arteries and capillaries and thereby promote coagulation and limit blood loss.

Elder: A spiritual shepherd and overseer within a congregation of Jehovah's Witnesses.

Electrocautery: A technique used during surgery to control bleeding that employs a scalpel-like device using electrical current to cauterize or 'burn' the tissues while it cuts. This serves to seal capillary vessels and small arteries. Similar devices are located in nearly every operating room in the United States and are routinely used. The cost is not significant.

Elevating body part above level of heart: A technique for reducing pressure in the veins of certain areas of the body and thereby limiting bleeding. This technology works best in cases of minor lacerations and abrasions located on the extremities.

Endoscope: A tube-like device that is capable of viewing internal structures of the digestive tract without having to perform surgery. Some are constructed to perform limited surgical procedures as well. Its greatest use involves finding and controlling internal bleeding in the stomach and intestines.

Erythropoietin: A medication that is a genetically produced form of a naturally occurring hormone in the body. This drug directly stimulates the bone marrow to produce more red blood cells. The hormone may contain albumin (a minor component of blood) and, if so, taking it would be a conscience matter.

Estrogen/Progesterone: A medication used in the treatment of acute episodes of bleeding such as those from the esophagus. Estrogen/Progesterone are naturally occurring female hormones.

Folic acid: A medication that is a member of the Vitamin B complex family and is a necessary component for red blood cell production. It can be recommended almost universally in any case of anemia.

Gamma knife radiosurgery: A large device the size of a small house that employs a high-energy radiation source to 'burn' tumors and aneurysms non-invasively. The availability is very limited and is useful mainly for procedures involving the brain.

Gelatin: A member of the colloid family of intravenous fluids. It is made up of proteins suspended in water and is used as a plasma substitute.

Gelfoam: A member of the family of topical hemostatic agents that is used to decrease blood loss from open wounds and is used mainly during surgery.

Granulocyte-Colony Stimulating Factor (G-CSF): A medication that is a genetically produced form of a naturally occurring hormone in the body. This drug directly stimulates the bone marrow to produce more white blood cells. It can be helpful in speeding recovery from cancer treatments that suppress the immune system and bone marrow.

Hemodilution: A procedure that involves directing a volume of a patient's blood outside the body and then adding a volume expander to dilute the remaining blood in the circulatory system. Diluting the patient's blood decreases the amount of red blood cells lost during surgery. After surgery, the volume of collected blood in the external circulation is returned to the body. This procedure is a conscience matter for Christians-if blood is not stored and if the equipment is arranged in a circuit that is constantly linked to the patient's circulatory system.

Hemolytic/Hemolysis: The destruction or dissolution of red blood cells, with subsequent release of hemoglobin.

Hemopad: One of the topical hemostatic agents. It is derived from animal collagen and is in the form of a sterile pad. Collagen is a natural promoter of clotting activity.

Hemostatic agents: Medicines that promote coagulation.

Hetastarch: An intravenous fluid of the colloid family. The main components are distilled water and amylopectin and its use is volume expansion.

HIS: {Hospital Information Services}- A committee and support staff found at the Watchtower Bible and Tract Society. This committee oversees the HLC function worldwide.

HLC: {Hospital Liaison Committee}- A committee of Jehovah's Witness elders found in each major city in the U.S. Their commission is to assist in locating cooperative physicians and hospitals by geographic region. They have received special training in order to facilitate dialogue with healthcare executives, physicians and lawyers.

Hospitality List: A list of Jehovah's Witness families within close proximity of a hospital. These families have "opened up" their homes to family members and friends of Jehovah's Witness patients who may have traveled from out of town for medical treatment.

Hyperbaric Oxygen Therapy: A technique in which a person is placed into a sealed chamber which is then pressurized. The device works on the principle that a gas under pressure can be forced to dissolve in a liquid. This technique is similar to forcing carbon dioxide into a carbonated beverage. It is useful in managing acute anemia and deep-seated infections, especially in bones.

Hypertonic saline: A member of the crystalloid family of intravenous fluids. This solution has a higher than normal concentration of salt in the solution. It is useful on cases involving shock but has come under some scrutiny as of late.

Hypotensive anesthesia: A technique of lowering the blood pressure of an individual during surgery to decrease the amount of blood loss. It is most effective in orthopedic procedures but can be used with nearly all surgeries.

Interleukin-3: A medication that is being investigated as a stimulant of the bone marrow to produce platelets. This drug is in Phase II FDA testing and may be available in special circumstances, depending on the hospital involved.

Immunosuppressive agent: A medication that can be given to an individual whose immune system, acting abnormally, begins to destroy normal cells such as red blood cells or platelets. Examples include cyclosporine and prednisone.

Induced hypothermia: A technique of lowering an anemic patient's body temperature in order to decrease metabolic activity, heart rate and oxygen consumption. The objective is to lessen the load on decreased numbers of red blood cells.

Intraoperative blood salvage: A procedure that uses a device (such as "Cell Saver") to aspirate shed blood from the operating field. It filters the blood and returns either whole blood or washed red cells to the patient. This is a conscience matter for Christians if blood is not stored and if the equipment is arranged in a circuit that is constantly linked to the patient's circulatory system.

Iron Dextran: A medication that can be given by injection. Iron is a necessary building block for red blood cells. Under normal conditions the body maintains a good supply of iron in storage. However, in cases where there are digestive tract difficulties (e.g. ulcers, Crohn's disease, etc.), enough iron may not be absorbed by the digestive tract and, in this case, it may be necessary to give iron by injection. Iron dextran can augment Erythropoietin if they are given together. The two most familiar forms of iron dextran include Imferon and Infed.

Kingdom Hall: The physical place of worship and congregational gatherings utilized by Jehovah's Witnesses.

Laser surgery: A device has similar activity as that of an electrocautery device but employs light instead of electricity. Such techniques are mainly used for specific types of surgery such as those upon the eye.

Maintenance of intravascular volume: A technique of great importance in the acute phase of blood loss. The body is able to adapt to severe blood loss only if the circulating volume of fluid in the body in maintained. Without adequate blood volume, the heart is unable to pump properly.

Medical Antishock Trousers (M.A.S.T.): A device used to help control shock by compressing the legs and causing pooled blood to be forced into circulation. This assures blood flow to vital organs.

Meticulous hemostasis: A technique of occluding every bleeding vessel that is encountered in the operating field and exercising great care to avoid accidents. This procedure is mainly a matter of skill and caution, and does not require any major surgical equipment. It can be applied to nearly all surgical procedures.

Microsampling: A procedure involving blood sampling equipment that is capable of using as little as 1/2ml or five drops of blood for diagnostic purposes. An adult sample ranges near 10ml. This procedure is vital in caring for newborns, children, or adults under intensive hospital care.

Microwave coagulating scalpel: A device that employs microwave energy to perform similar activity to that of electrocautery but is capable of cauterizing greater areas of tissue at one time. This device has limited availability and is useful mainly for surgery on highly vascular organs such as liver and spleen.

Multiple tests per sample: A technique of conserving blood by using one sample of blood drawn to run several tests. This is normally done by timing the multiple tests needed so that they can be done at the same time or by using a machine capable of measuring many blood values simultaneously.

Normal saline: A member of the crystalloid family of intravenous fluids. This solution is 'normal' in that it has the same concentration of salt (sodium chloride) and same pH as plasma. This is one of the most widely used intravenous solutions.

Nutritional support: A technique where adequate nutrition is maintained despite some abnormal condition that may be interfering. This is most noticeable in cases involving the digestive tract, such as in the instance of a perforated ulcer, when the patient is unable to ingest food normally. Food may be given parenterally (through a vein) or by bypassing the affected area (with a tube). Blood cells need building blocks to grow and food provides those building blocks.

Pentastarch: An intravenous fluid of the colloid family. The main components are distilled water and amylopectin and its use is volume expansion.

Perfluorochemicals: An intravenous fluid that has the ability to carry oxygen in extremely critical medical emergencies. The only approved perfluorocarbon product is Fluosol DA-20. The effect of Fluosol DA-20 is only seen in cases of extreme anemia and it may not always be available.

Preoperative planning: A technique that requires the surgical team to prepare in advance for any needs, expected or unexpected, during a critical operation. This advance planning requires giving consideration to the need of and setting up of equipment for procedures such as intraoperative blood salvage, hemodilution, hypothermia, hypotension, and others. The more that can be anticipated and cared for in advance, the less trauma the patient will have to endure.

Prompt surgery: A technique of arresting bleeding by surgical repair before blood levels have fallen to extremely low levels. The mortality rate when surgery is delayed for greater than 24 hours is near 75%, but if surgery is performed within 24 hours, mortality drops to 20%.

PVG {Patient Visitation Group}: A group of Jehovah's Witness elders found in each major city in the U.S. Members of this group, under the guidance of the HLC, regularly visit Jehovah's Witness patients within a hospital. They provide pastoral care and spiritual encouragement.

Reduction of blood flow to skin: A technique used in treating the burn patient to reduce blood loss during debridement. During debridement, the dead skin is 'scraped' off, exposing the raw flesh underneath. Decreasing blood flow to the surface lessens blood loss during debridement. However, such restricted blood flow cannot be maintained for extended periods of time.

Ringers lactate: A member of the crystalloid family used for volume expansion during acute blood loss.

Shaw hemostatic scalpel: A device that cauterizes while it cuts, employing an electrically heated metal cutting blade. This device is not readily available.

Staging of complex procedures: A technique in which surgery may be performed in two or more smaller procedures instead of one large one. This has the advantage of having the patient spend less time on the operating table, thereby decreasing blood loss. This procedure also allows more time for the hemoglobin levels to rise before the next procedure is performed.

Surgical positioning: A technique in which areas that are undergoing surgery are kept elevated above the rest of the body. This helps decrease venous pressures in the affected area and thereby decreases blood loss during surgery.

Surgicel: A member of the topical hemostatic agent commonly used during surgery.

Thrombogen: A medication that uses a component of the natural clotting mechanism, thrombin, and places it directly onto a wound for closing off bleeding vessels. The thrombogen is made from a derivative of blood and using it would therefore be a conscience matter.

Tissue adhesives: A medication that is derived from various products of blood clotting that is applied to certain areas of tissue that bleed easily, such as liver and spleen. This technique has limited use and its application would be a conscience matter for Christians comparable to that of other blood products.

TMSP: {Transfusion Free Medicine and Surgery Program}- A special in-house hospital program that services those individuals who either for religious, ethical or medical reasons, choose not to receive blood as part of their medical/surgical treatment.

Tourniquet: A technique of applying external pressure to an area by compressing the underlying blood vessels, thereby stopping blood flow. This technique is used for short periods of time, because long term use can cause extremity damage.

Tranexamic acid (Cyklokapron): A medication that slows or stops the breakdown of blood clots. During clot formation, while clotting factors are at work, chemicals are released simultaneously that serve in a counterbalancing way to break down the clot, ensuring that it does not grow too large. However, if the clotting mechanism is impaired, as in hemophilia or low platelet levels, this breakdown activity may need to be slowed or stopped so that there is sufficient clot formation to prevent bleeding.

Transcutaneous oxygen monitoring: A technique employing several different devices which are able to read body oxygen levels through skin without requiring blood withdrawal. These are most valuable in cases where oxygen levels need to be monitored (e.g., respiratory distress) and where blood removal must be severely curtailed due to the patient's having only a small amount of blood (e.g., newborns, severe anemia).

Trendelenburg/shock position: A technique in which the patient is placed in a position where the head is lower than the legs. This technique helps in shock by maintaining adequate blood flow to the brain which is more sensitive to a lack of oxygen than any other organ in the body.

Vasopressin (Pitressin): A medication that causes a contraction of blood vessels. This is particularly useful in cases of blood loss where blood flow needs to be reduced to a certain area (e.g., burns, crushing injuries).

Vincristine (Oncovin): A medication use primarily to treat leukemia but that also has been successful in treating disorders involving platelet destruction due to improper immune system response such as idiopathic thrombocytopenia purpura (ITP).

Vitamin B-12: A medication that is necessary component in the manufacturing of red blood cells. B-12 can be done recommended in nearly all cases of anemia.

WTBTS {Watchtower Bible and Tract Society}: The world headquarters of Jehovah's Witnesses located in Brooklyn, New York.