Questions From Readers
◼ Do Jehovah’s Witnesses accept injections of a blood fraction, such as immune globulin or albumin?
Some do, believing that the Scriptures do not clearly rule out accepting an injection of a small fraction, or component, taken from blood.
The Creator first laid upon all mankind the obligation to avoid taking in blood: “Every moving animal that is alive may serve as food for you . . . Only flesh with its soul—its blood—you must not eat.” (Genesis 9:3, 4) Blood was sacred and so could be used only in sacrifice. If not used in that way, it was to be disposed of on the ground.—Leviticus 17:13, 14; Deuteronomy 12:15, 16.
This was no mere temporary restriction for Jews. The need to abstain from blood was restated for Christians. (Acts 21:25) Around them in the Roman Empire, God’s law was commonly broken, since people ate food made with blood. It was also broken for “medical” reasons; Tertullian reports that some men took in blood thinking that it could cure epilepsy. ‘They quaffed with greedy thirst the blood of criminals slain in the arena.’ He added: “Blush for your vile ways before the Christians, who have not even the blood of animals at their meals.” Jehovah’s Witnesses today are just as determined not to violate God’s law, no matter how common it is for others to eat food made with blood. In the 1940’s, blood transfusions came into widespread use, and the Witnesses saw that obeying God required that they also avoid blood transfusions, even if doctors urged these.
At first, most transfusions were of whole blood. Later, researchers began to separate blood into its primary components, for doctors concluded that a certain patient might not need all major parts of blood. If they gave him only one component, it would be less risky for him, and the doctors could get more use out of the blood available.
Human blood can be separated into dark cellular material and a yellowish fluid (plasma, or serum). The cellular part (45 percent by volume) is made up of what are commonly called red cells, white cells, and platelets. The other 55 percent is the plasma. This is 90 percent water, but it carries small amounts of many proteins, hormones, salts, and enzymes. Today, much of the donated blood is separated into the primary components. One patient may be given a transfusion of plasma (perhaps FFP, fresh frozen plasma) to treat shock. But an anemic patient might be given packed red cells, that is, red cells that had been stored and then put in a fluid and transfused. Platelets and white cells are also transfused but less commonly.
In Bible times men had not devised such techniques for using these components. God simply commanded: ‘Abstain from blood.’ (Acts 15:28, 29) But why should anyone think that it would make a difference whether the blood was whole or had been separated into these components? Though some men drank blood, Christians refused even if it meant death. Do you think that they would have responded differently if someone had collected blood, allowed it to separate, and then offered them just the plasma or just the clotted part, perhaps in blood sausage? No, indeed! Hence, Jehovah’s Witnesses do not accept transfusions of whole blood or of its primary components (red cells, white cells, platelets, or plasma) used to accomplish a similar purpose.
As the question suggests, though, scientists have learned about specialized blood fractions and how to employ such. A common issue involves the plasma proteins—globulins, albumin, and fibrinogen. Likely, the most widespread therapeutic use of such is injecting immune globulin. Why is that done?
Your body can produce antibodies against certain diseases, giving you active immunity. This is the basis for advance inoculation with a vaccine (toxoid) against polio, mumps, rubella (measles), diphtheria-tetanus-pertussis, and typhoid fever. However, if someone has recently been exposed to certain serious diseases, physicians may recommend an injection of a serum (antitoxin) to give him immediate passive immunity. Until recently such injections have been made by extracting immune globulin, which contains antibodies, from a person already immune.* The passive immunity gained from the injection is not permanent, for the injected antibodies pass out of his system in time.
In view of the command to ‘abstain from blood,’ some Christians have felt that they should not accept an immune globulin (protein) injection, even though it was only a blood fraction. Their stand is clear and simple—no blood component in any form or amount.
Others have felt that a serum (antitoxin), such as immune globulin, containing only a tiny fraction of a donor’s blood plasma and used to bolster their defense against disease, is not the same as a life-sustaining blood transfusion. So their consciences may not forbid them to take immune globulin or similar fractions.* They may conclude that for them the decision will rest primarily on whether they are willing to accept any health risks involved in an injection made from others’ blood.
It is significant that the blood system of a pregnant woman is separate from that of the fetus in her womb; their blood types are often different. The mother does not pass her blood into the fetus. Formed elements (cells) from the mother’s blood do not cross the placental barrier into the fetus’ blood, nor does the plasma as such. In fact, if by some injury the mother’s and the fetus’ blood mingle, health problems can later develop (Rh or ABO incompatibility). However, some substances from the plasma cross into the fetus’ circulation. Do plasma proteins, such as immune globulin and albumin? Yes, some do.
A pregnant woman has an active mechanism by which some immune globulin moves from the mother’s blood to the fetus’. Because this natural movement of antibodies into the fetus occurs in all pregnancies, babies are born with a degree of normal protective immunity to certain infections.
It is similar with albumin, which doctors may prescribe as a treatment for shock or certain other conditions.* Researchers have proved that albumin from the plasma is also transported, though less efficiently, across the placenta from a mother into her fetus.
That some protein fractions from the plasma do move naturally into the blood system of another individual (the fetus) may be another consideration when a Christian is deciding whether he will accept immune globulin, albumin, or similar injections of plasma fractions. One person may feel that he in good conscience can; another may conclude that he cannot. Each must resolve the matter personally before God.
With recombinant DNA, or genetic-engineering, techniques, scientists are developing similar products that are not made from blood.
One example is Rh immune globulin, which doctors may recommend when there is Rh incompatibility between a woman and her fetus. Another is Factor VIII, which is given to hemophiliacs.
Evidence shows that nonblood volume replacement fluids (such as hetastarch [HES]) can be used effectively to treat shock and other conditions for which an albumin solution might have been used previously.