Challenging the management of bleeding and coagulopathy in ascending aortic surgery in a Jehovah's Witness patient: case report
Not transfusing in certain medical settings can be a life-threatening decision; however, Jehovah's Witness patients who reject transfusions have led to learning and multiple medical interventions to avoid it. Despite this, heart surgery follows a specialty that is clearly related to the risk of transfusion, making operating on a Jehovah's Witness patient a challenge.
An ascending aorta surgery was performed on a Jehovah's Witness patient, where different strategies were applied, both for blood saving and for the prevention and management of coagulopathy.
Surgery of the ascending aorta with extracorporeal circulation was successfully performed without requiring administration of blood components.
Adequate planning and implementation of bleeding prevention strategies and coagulopathy management may contribute to avoid and/or reduce the administration of blood products, allowing for the absence of transfusions to not be utopia in major cardiac surgery.
2. Ferraris VA, Brown JR, Despotis GJ, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines. Ann Thorac Surg 2011;91:944-982.
3. Walpoth B, Galliker B, Spirig P, et al. Use of Epoetin Alfa in autologous blood donation programs for patients scheduled for elective cardiac surgery. Semin Hematol 1996;33 (2 suppl 2):75-76.
4. Vaislic CD, Dalibon N, Ponzio O, et al. Outcomes in cardiac surgery in 500 consecutive Jehovah'sWitness patients: 21 year Experience. J Cardiothorac Surg 2012;7:95.
5. Sigaut S, Tremey B, Ouattara A, et al. Comparison of two doses of tranexamic acid in adults undergoing cardiac surgery with cardiopulmonary bypass. Anesthesiology 2014;120:590-600.
6. Wademan BH, Galvin SD. Desmopressin for reducing postoperative blood loss and transfusion requirements following cardiac surgery in adults. Interact Cardiovasc Thorac Surg 2014;18:360-370.
7. Van Osch D, Dieleman JM, Nathoe HM, et al. Intraoperative highdose dexamethasone in cardiac surgery and the risk of rethoracotomy. Ann Thorac Surg 2015;100:2237-2242.
8. Whitlock RP, Devereaux PJ, Teoh KH, et al. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial. Lancet 2015;386:1243-1253.
9. Kristeller JL, Jankowski A, Reinaker T. Role of corticosteroids during cardiopulmonary bypass. Hosp Pharm 2014;49:232-236.
10. Cappabianca G, Mariscalco G, Biancari F, et al. Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery. Crit Care 2016;20:5.
11. Luciani GB, MenonT, Vecchi B, et al. Modified ultrafiltration reduces morbidity after adult cardiac operations. A prospective, randomized clinical trial. Circulation 2001;104 (12 Suppl 1):I253-I259.
12. Carless PA, Henry DA, Moxey AJ, et al. Cell salvage for minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2010;17:CD001888.
13. Barile L, Fominskiy E, Di Tomasso N, et al. Acute normovolemic hemodilution reduces allogeneic red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis of randomized trials. Anesth Analg 2017;124:743-752.
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