The Watchtower and Jehovah’s Witnesses in general still proclaim their “no blood” position. As you will see in this section, that claim is misinformed. The Watchtower has approved the use of all red cell, white cell, platelet and plasma derivatives. The list of blood products Jehovah’s Witnesses can choose to use in good conscience has consistently grown larger over the last four decades. If fact, the list has become so extensive, it’s easier to say what they don’t permit:
- Whole Blood
- Red Cells
- White Cells
The prohibition of whole blood is practically meaningless, because whole blood is almost never transfused. The position can be summarized by the following diagram:
We will break down each of these components in some detail below as well as look at various medical procedures and blood transfusions currently approved by the Watchtower for Jehovah’s Witnesses.
Red Blood Cells – Not Approved
The red cell is by far the largest component of blood, comprising about 45% of its volume. A red cell is a tiny doughnut shaped bag of hemoglobin as shown here. It has no nucleus and serves to transport hemoglobin throughout the body. The membrane accounts for only 1% of the total weight of the red cell.1
Hemoglobin (Approved): Hemoglobin is the essential protein responsible for the transport of oxygen and carbon dioxide and is the major component of blood. This Hemoglobin accounts for about 1/3 of the volume of a red cell. Its approval for use by the Watchtower back in 2000 was startling to long-time observers and most Jehovah’s Witnesses alike. At present Hemoglobin based blood products like Hemopure remain in the research and development stage in most countries (except South Africa), although there are plenty of documented cases of Jehovah’s Witnesses using these products – at times on an emergency compassionate use basis.
White Blood Cells – Not Approved
There are five different leukocytes or white cells that can be found in the blood stream. These are part of the immune system and fight foreign invaders like viruses and bacteria. In total they comprise about 1% of the blood volume in a healthy person. They are occasionally prescribed for infections that don’t respond to antibiotics. White cells are banned but all the ingredients and derivatives are all permitted.
Interferons (Approved): Anti-viral agent and immune system upregulator.
Interleukins (Approved): An important group of Cytokines essential to the function of the immune system. There are rare conditions which result in deficiencies.
Granuloycye Macrophage – Colony Stimulating Factor (GM-CSF) (Approved): Stimulate the body’s production of neutrophils. Man-made versions are available.
Platelets – Not Approved
Also referred to as “thrombocytes”, they are specialized blood cells responsible for stopping bleeding. Like the red cell, they have no nucleus. They are the smallest of the blood components, amounting to far less than 1% of blood volume, yet they remain banned. They are used to treat Thrombocytopenia, side effects of chemotherapy or a low platelet count due to lumbar puncture or bone marrow aspiration. The platelet is banned for Jehovah’s Witnesses but like the red and white cell, everything within it are permitted.
Platelet Derived Growth Factor (Approved): Used topically to accelerate wound healing.
Platelet Gel (Approved): Derived from the patients own blood by separating the platelets via centrifuge and special processing. Used for surgical wound healing. This amounts to autologous blood transfusion.
Plasma – Not Approved
Plasma is a yellowish fluid containing about 92% water, 7% proteins, clotting factors, salt, sugars, fats, hormones and vitamins. Concentrates of the specifics proteins are prepared from huge pools of Plasma through a process known as fractionation developed during World War II. They are heat-treated and/or solvent detergent-treated to kill certain viruses, including HIV and hepatitis B and C. Plasma derivatives include:
Albumin (Approved): Blood contains about 2.2 % albumin by volume. (White Cells – which are prohibited – comprise about 1% of blood volume). Many Witnesses are puzzled as to why some larger blood components are permitted and some smaller ones are forbidden. The red blood cell stimulant EPO is an albumin based blood product.1
Albumin is often used to treat burns. A typical treatment for third degree burns (30-50 %) requires 600 grams of albumin. Producing this amount requires about 45 liters of whole blood. How can anyone call this “a small fraction?”
It is also obvious that the blood used to derive albumin is not ‘poured out,’ but stored, which is prohibited for a blood transfusion but permitted in this context. It is of some interest to note the following comment from the Watchtower:
“While this physician argues for the use of certain blood fractions, particularly albumin, such also come under the Scriptural ban. . – Awake! 09/08/1956 p. 20
The Watchtower quietly reversed its position on albumin in 1981 leading many to wonder whether the previous ban on its use was from God or from men. No official acknowledgement was made for many years.
Alpha 1-Proteinase Inhibitor Concentrate (Approved): Used to treat Emphysema.
Antithrombin III (Approved): Used to treat Antithrombin III deficiency. A recombinant “man-made” version is now available.
Anti-Inhibitor Coagulation Complex (AICC) (Approved):Used for treating Hemophila A & B to reduce bleeding in acute espisodes.
C1 Esterase Inhibitor (Approved): Used to treat acute abdominal or facial attacks of hereditary angioedema.
Cryoprecipitated AHF (Approved): The portion of Plasma that is rich in certain clotting factors, including Factor VIII, fibrinogen, von Willebrand factor and Factor XIII. Cryoprecipitated AHF is removed from Plasma by freezing and then slowly thawing the Plasma. It is used to prevent or control bleeding in individuals with hemophilia and von Willebrand’s disease, which are common, inherited major coagulation abnormalities. Its use in these conditions is reserved for times when viral-inactivated concentrates containing Factor VIII and von Willebrand factor are unavailable and Plasma components must be used. Note the following link from the Australian Red Cross and its description as a blood transfusion.
That Watchtower realizes this is a major component of blood is shown by their October 21, 2014 letter to all HLC committees in the U.S. wherein they acknowledge and proudly distribute the Dept. of Veterans Affairs Directive 1089(1). Therein Cryoprecipitate is listed among the major components of blood.
Cryosupernatant (Approved): Also referred to as cryo-poor plasma because the Cryoprecipitated AHF has been removed. This single blood product makes up a staggering 99% of blood plasma – hardly a small fraction of blood.
Fibrin Sealant Patch (Approved): Used to control soft tissue bleeding when standard surgical methods are ineffective.
Fibrinogen Concentrate (Approved): Used for treating acute bleeding in congenital fibrinogen deficiency.
Gamma Globulin (Approved): Use to treat Hempatitis A or the measles. Also in some kidney transplants and immune deficiencies.
Hepatitis B Immune Globulin (HBIG) (Approved): Used to treat and prevent Hepatitis B.
Hemophiliac preparations (Factor VIII and IX) (Approved): Effective treatment requires a preparation called factor VIII, which assists in clotting and is made of the pooled blood of many individuals. The WTS has frequently argued that these are small blood fractions. In truth, however, it takes about 9000 kilograms of whole blood to make one 0.1 gram dose of Factor VIII. A person suffering from severe hemophilia typically requires several doses a year.
The Watchtower Society is not ignorant of this:
“Each batch of Factor VIII is made from plasma that is pooled from as many as 2,500 blood donors.” (The Watchtower, June 15, 1985, p. 30)
“Dr. Margaret Hilgartner of the New York Hospital-Cornell Medical Center said: “A severe hemophiliac is exposed to the blood of 800,000 to 1 million different people every year.”” (Awake! Oct. 8, 1988, p. 11)
More than 250,000 blood donations are required annually to produce the factor VIII, and factor IX that is consumed by the Jehovah’s Witness community. Huge vats could be filled with all of the human blood that is stored and processed to meet the needs of Witness Hemophiliacs. The Watchtower ignores these facts when explaining why it allows use of these “small fractions,” but cynically emphasizes them when it uses AIDS as propaganda against blood transfusions.
Immunoglobulins: There are many different uses of these vital blood products. We touch on some of them below.
- Human Immune Globulin (HIG) (Approved): Used to treat and prevent, among other things, Hepatitis A
- Rabies Immune Globulin(RIG) (Approved): Used to treat and prevent rabies.
- RhO Immune Globulin (RhoGam) (Approved): Given to Rh negative mothers to prevent Hemolytic Disease of the newborn in future pregnancies.
- Tetanus Immune Globulin (Approved): (Tetanus Shot)
Profilnine Complex Concentrate (Approved): Used to reverse acquired coagulation factor deficiency with patients with acute bleeding.
Protein C Complex (Approved): Used to treat Congenital Protein C deficiency, thrombosis and purpura fulminans.
Thrombin (Approved):Aids hemostasis in capillaries when standard control is impractical or ineffective.
Blood Donation: If done strictly for the purpose of further fractionation for allogeneic or autologous transfusion.
Dialysis: Where the blood of a Jehovah’s Witness suffering from Kidney failure is regularly circulated through a Dialysis machine to be filtered and returned to the patient.
Epidural Blood Patch: A small amount of the patients blood is injected into the membrane surrounding the spinal cord to repair leakage from a lumbar puncture.
Heart-lung machine: As we have seen, in a Watchtower article the Society explicitly prohibited pre-operative blood collection for autologous transfusions, but allowed another procedure:
“In a somewhat different process, autologous blood can be diverted from a patient to a hemodialysis device (artificial kidney) or a heart-lung pump. The blood flows out through a tube to the artificial organ that pumps and filters (or oxygenates) it, and then it returns to the patient’s circulatory system. Some Christians have permitted this if the equipment is not primed with stored blood. They have viewed the external tubing as elongating their circulatory system so that blood might pass through an artificial organ. They have felt that the blood in this closed circuit was still part of them and did not need to be ‘poured out.’” (The Watchtower, March 1, 1989, p. 30)
Hemodilution/Intraoperative Blood Salvage: During surgery doctors use blood aspiration with automatic anticoagulant mixing, and the blood is collected into a blood reservoir. It is then drained by gravity into the blood bag, and stored in a lowered position until it is filled. When the blood bag is filled, it is raised to the top of the assembly, and the blood is reinfused. Although it is hard to see the blood as still being a part of the circulatory system, almost all Jehovah’s Witnesses accept the procedure once they are told that the Watchtower Society has approved its use, and that it does not violate any scriptural principles despite the fact that it is clearly a blood transfusion albeit autologous.
Labeling or Tagging: The patient’s blood is withdrawn and mixed with medicine, then returned via transfusion.
Plasmapheresis: Similar to Dialysis in procedure but used to treat Myasthenia Gravis and other immune system diseases. The process is also used during plasma donation.
If we add up everything in blood that is separately permitted it amounts to 100% of blood volume. Clearly it is disingenuous for the Watchtower or Jehovah’s Witnesses to claim they don’t accept blood transfusions. As we have seen in this section, nothing could be further from the truth. What then does it mean to abstain from blood? There is not and cannot be a straightforward answer to this question. In light of the information just presented, it can be seen that it is not so much a question of abstaining from blood as it is a question of what components of blood must a Witness abstain from and why. Why are Witnesses permitted some blood transfusions and not others?
Much like the religious leaders of Jesus day, Watchtower leaders appear caught in a maze of legalism and nit-picking. Their prohibition against storing blood is hopelessly inconsistent. Many Jehovah’s Witnesses would no doubt see that the logic that permits a heart-lung machine, cell salvage or blood fraction also permits storing their own blood – if they were allowed to exercise their own judgment. After all, the only argument against it comes from a rule in the Law of Moses requiring blood from a killed animal to be poured out (Deut 12:24). Following the rule demonstrated that a person understood the animal’s life to come from God. Obviously, then, these considerations cannot apply to autologous blood transfusions, since no one has died. The blood is put back into the person from whom it was taken.
1-Human blood is composed of 55% plasma and 45% formed elements (From chart) 1994 Elaine N Marieb R.N. Ph.D. Essentials of Human Anatomy and Physiology – 4th edition p. 291
“Plasma, which is approximately 90% water, is the liquid part of blood.” Ibid p. 290
“Solutes make up about 10% of the plasma volume of which 7% are proteins.” 1990 Ennio C Rossi, Toby L. Simon, Gerald S. Moss – Principles of Transfusion Medicine p. 307
“The Concentration of Albumin is about 40mg/ml, an amount that represents about 60% of the total plasma protein.” Ibid p. 308
Comment: Since 55% of the total blood volume is plasma and 7% of that plasma is protein and 60% of that protein is albumin, then figuring the percentage that albumin comprises of the total blood volume is accomplished by the following computation: .6 X 7 X .55 equals 2.31 percent.
See the following WTS references for a historical verification of changes in policy:
Albumin: Awake! 09/08/1956 p. 20; WT 11/1/61 P. 669; Awake 6/22/82 P. 25; and WT 10/1/94 P.31; WT 6/1/90 P. 31
Vaccines/Serums: Golden Age, 5/1/29, p. 502, #40; WT 12/15/52 P. 764; Awake! 01/08/1954 p. 24; WT 9/15/1958 p. 575; WT 6/1/74 P. 351-352
Illustration from Awake! 10/22/90, p. 4.